Kamisan Atan Ixora, Shek Ka Lai, Furtado Glefy Inacio, Caudwell-Hall Jessica, Dietz Hans Peter
*Department of Obstetrics, Gynaecology & Neonatology, Sydney Medical School Nepean, The University of Sydney, NSW, Australia; †Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; ‡Department of Obstetrics & Gynaecology, Liverpool Clinical School, University of Western Sydney, Australia, Liverpool NSW, Australia §Wexham Park Hospital, Slough, Berkshire, United Kingdom.
Female Pelvic Med Reconstr Surg. 2016 Nov/Dec;22(6):442-446. doi: 10.1097/SPV.0000000000000311.
Levator avulsion is associated with pelvic organ prolapse in women. It is diagnosed clinically by a widened gap on palpation between the insertion of the puborectalis muscle on the inferior pubic ramus and the urethra. This gap can also be assessed on imaging. This study aimed to determine the association between sonographically determined levator-urethral gap (LUG) measurements and symptoms and signs of prolapse.
This is a retrospective study on 450 women seen in a tertiary urogynecological center for symptoms of pelvic floor dysfunction between January 2013 and February 2014. All had a standardized interview, International Continence Society Pelvic Organ Prolapse Quantification assessment and 4-dimensional translabial ultrasound. Post-imaging analysis of archived ultrasound volumes for LUG measurement was undertaken on tomographic slices at the plane of minimal hiatal dimensions and within 5-mm cranial to this plane, bilaterally at an interslice interval of 2.5 mm, blinded against all clinical data. A LUG of 25 mm or greater was considered abnormal.
Mean LUG and maximum LUG in individuals were 22.5 mm (SD, 4.6) and 26.4 mm (SD, 6.0), respectively, with at least 1 abnormal LUG in 51% (n = 222). An abnormal LUG in all 3 slices involving the plane of minimal hiatal dimensions and within 5 mm cranial to this plane on at least 1 side was fulfilled in 24% (n = 103). The LUG measurements were strongly associated with bother, symptoms and signs of prolapse (P < 0.001 to 0.002). This remained significant on multivariate analysis controlling for potential confounding factors.
Sonographically determined LUG is strongly associated with symptoms, symptom bother, and pelvic organ prolapse on clinical examination and imaging.
提肌撕裂与女性盆腔器官脱垂相关。临床上通过触诊发现耻骨直肠肌在下耻骨支的附着点与尿道之间的间隙增宽来诊断。该间隙也可通过影像学评估。本研究旨在确定超声测定的提肌-尿道间隙（LUG）测量值与脱垂症状和体征之间的关联。
这是一项对2013年1月至2014年2月期间在一家三级泌尿妇科中心因盆底功能障碍症状就诊的450名女性进行的回顾性研究。所有患者均接受了标准化访谈、国际尿失禁学会盆腔器官脱垂定量评估和四维经阴唇超声检查。对存档的超声容积进行成像后分析，以测量LUG，在最小裂孔尺寸平面及该平面上方5毫米范围内的断层切片上进行，双侧切片间隔为2.5毫米，对所有临床数据进行盲法处理。LUG≥25毫米被认为异常。
个体的平均LUG和最大LUG分别为22.5毫米（标准差4.6）和26.4毫米（标准差6.0），51%（n = 222）的人至少有1个异常LUG。至少一侧在涉及最小裂孔尺寸平面及该平面上方5毫米范围内的所有3个切片中LUG异常的情况占24%（n = 103）。LUG测量值与脱垂的困扰、症状和体征密切相关（P < 0.001至0.002）。在控制潜在混杂因素的多变量分析中，这种相关性仍然显著。
超声测定的LUG与临床检查和影像学上的症状、症状困扰及盆腔器官脱垂密切相关。
