Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score

Abstract

The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage. Methods: This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe. Results: There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33 ± 2.49 vs. 8.19 ± 2.92, P < 0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P < 0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91 ± 2.74 cm 2 vs. 14.95 ± 2.60 cm 2 , P < 0.001). In addition, both MLH and LAD scores tended to increase at each stage. Conclusion: There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.

Three‐dimensional endovaginal ultrasound assessment using the levator ani deficiency score in primiparas: A replication study

“…In general, LAD category (rather than LAD score) is used guide the choice of intervention in clinical settings. 19 Our findings draw the attention to the limitation of the LAD score in a low-risk population given that the score has only three categories, with mild LAD also covering cases with a score of 0. In our opinion, this is a weakness of the scoring system and should be acknowledged if used in a population with unknown status of pelvic floor dysfunction.…”

“…The study neither assessed the muscle bulk of the LAM nor is applicable in cases of muscle avulsion, as there is no identifiable perimeter of the hiatal measurements in those cases. In general, LAD category (rather than LAD score) is used to guide the choice of intervention in clinical settings 19 …”

Is It a Refractory Disease?- Fecal Incontinence; beyond Medication

“…In addition, defecography and pelvic MRI are tests that can detect rectoceles and internal rectal prolapse, as well as see pelvic floor muscle activity during defecation (Fig. 1) [31,32]. Anorectal manometry evaluates the resting and squeezed anal sphincter function of patients [25].…”

The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum

“…3D ultrasound has a high spatial resolution of pelvic floor structure, and can observe the position of pelvic organs, fetal head circumference (HC) and levator hiatus diameter (LHS). The analysis of the ratio of LHS to head circumference in primiparous women may be helpful in assessing the progression of labor and analyzing the risk of levator ani muscle injury in the postpartum period, so as to better guide the clinical selection of appropriate delivery modalities [ 5 , 6 ].…”