Sydney Urodynamic Centres, Penrith, NSW, Australia.
Western Sydney University, Liverpool, NSW, Australia.
Ultrasound Obstet Gynecol. 2022 Nov;60(5):693-697. doi: 10.1002/uog.26034.
To define associations between partial levator trauma and symptoms and signs of pelvic organ prolapse (POP).
This was a retrospective study of 3484 women attending a tertiary urogynecology unit for symptoms of pelvic floor dysfunction between January 2012 and February 2020. All women underwent a standardized interview, clinical pelvic organ prolapse quantification (POP-Q) examination and tomographic ultrasound imaging of the pelvic floor. Women with full levator avulsion were excluded from analysis. Partial levator avulsion was quantified using the tomographic trauma score (TTS), in which slices 3-8 are scored bilaterally for abnormal insertions. Binomial multiple logistic regression was analyzed independently for the outcome variables prolapse symptoms, symptom bother and objective prolapse on clinical examination and imaging, with age and body mass index as covariates. Two continuous outcome variables, prolapse bother score and hiatal area on Valsalva, were analyzed using multiple linear regression.
Of the 3484 women, ultrasound data were missing or incomplete in 164 due to lack of equipment, clerical error and/or inadequate image quality. Full levator avulsion was diagnosed in 807 women, leaving 2513 for analysis. TTS ranged from 0-10, with a median of 0. Partial trauma (TTS > 0) was observed in 667/2513 (26.5%) women. All subjective and objective measures of POP were associated significantly with TTS, most strongly for cystocele. Associations were broadly linear and similar for all slice locations but disappeared after accounting for hiatal area on Valsalva.
Partial avulsion is associated with POP and prolapse symptoms. This association was strongest for cystocele, both on POP-Q and ultrasound imaging. The effect of partial avulsion on POP and prolapse symptoms is explained fully by its effect on hiatal area. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
定义部分肛提肌损伤与盆腔器官脱垂（POP）症状和体征之间的关系。
这是一项回顾性研究，共纳入 2012 年 1 月至 2020 年 2 月期间在一家三级妇科泌尿科就诊的 3484 名女性患者。所有女性均接受了标准化的访谈、盆腔器官脱垂定量（POP-Q）检查和经阴道盆底断层超声成像。对完全肛提肌撕裂的女性患者不进行分析。采用经阴道盆底断层超声成像的创伤评分（TTS）来定量部分肛提肌撕裂，即对第 3-8 个层面双侧进行异常附着的评分。采用二项式多变量逻辑回归分析，将年龄和体重指数作为协变量，对与脱垂症状、症状困扰和临床检查及影像学检查中客观脱垂相关的结局变量进行独立分析。对脱垂困扰评分和 Valsalva 时的疝孔面积这两个连续的结局变量，采用多元线性回归分析。
在 3484 名女性中，有 164 名女性由于设备缺乏、文书错误和/或图像质量不充分，超声数据缺失或不完整。807 名女性诊断为完全肛提肌撕裂，2513 名女性用于分析。TTS 范围为 0-10，中位数为 0。2513 名女性中有 667 名（26.5%）存在部分创伤（TTS>0）。TTS 与所有 POP 的主观和客观测量均显著相关，与膀胱膨出的相关性最强。相关性呈线性，在所有层面的位置均相似，但在考虑到 Valsalva 时疝孔面积后，这种相关性就消失了。
部分肛提肌撕裂与 POP 和脱垂症状相关。这种相关性在膀胱膨出的 POP-Q 和经阴道盆底断层超声成像上都最强。部分肛提肌撕裂对 POP 和脱垂症状的影响完全可以用其对疝孔面积的影响来解释。
