Pelvic cross-sectional area at the level of the levator ani and prolapse
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ORIGINAL ARTICLE
Pelvic cross-sectional area at the level of the levator ani and prolapse Anne G. Sammarco 1,2 John O. Delancey 2,5
&
David Sheyn 2,3 & Christopher X. Hong 2,4 & Emily K. Kobernik 5 & Carolyn W. Swenson 5 &
Received: 10 July 2020 / Accepted: 21 September 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Intraabdominal pressure acts on the pelvic floor through an aperture surrounded by bony and muscular structures of the pelvis. A small pilot study showed the area of the anterior portion of this plane is larger in pelvic organ prolapse. We hypothesize that there is a relationship between prolapse and anterior (APA) and posterior (PPA) pelvic cross-sectional area in a larger, more diverse population. Study design MRIs from 30 prolapse subjects and 66 controls were analyzed in this case-control study. The measurement plane was tilted to approximate the level of the levator ani attachments. Three evaluators made measurements. Patient demographic characteristics were compared using Wilcoxon rank-sum and Fisher’s exact tests. A multivariable logistic regression model identified factors independently associated with prolapse. Results Controls were 3.7 years younger and had lower parity, but groups were similar in terms of race, height, and BMI. Cases had a larger APA (p < 0.0001), interspinous diameter (ISD) (p = 0.001), anterior-posterior (AP) diameter (p = 0.01), and smaller total obturator internus muscle (OIM) area (p = 0.002). There was no difference in the size of the PPA(p = 0.12). Bivariate logistic regression showed age (p = 0.007), parity (p = 0.009), ISD (p = 0.002), AP diameter (p = 0.02), APA (p < 0.0001), and OIM size (p = 0.01) were significantly associated with prolapse; however, PPA was not (p = 0.12). After adjusting for age, parity, and major levator defect, prolapse was significantly associated with increased anterior pelvic area (p = 0.001). Conclusions We confirm that a larger APA and decreasing OIM area are associated with prolapse. The PPA was not significantly associated with prolapse. Keywords Pelvic organ prolapse . Magnetic resonance imaging . Pelvic floor . Biomechanics
Introduction This paper was presented as a Poster at the 46th Annual Scientific meeting of the Society of Gynecologic Surgeons in Jacksonville, FL, July, 2020. * Anne G. Sammarco [email protected] 1
Female Pelvic Medicine and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
2
Society for Gynecologic Surgeons Pelvic Anatomy Group- Imaging, East Dundee, IL, USA
3
Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center/ Metro Health Medical Center, Cleveland, OH, USA
4
Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
5
Female Pelvic Medicine and Reconstructive Surgery, Michigan Medicine, Ann Arbor, MI, USA
There are many factors involved in causing pelvic organ prolapse (POP), with age, parity, operative vaginal delivery, and levator ani injury being the mos
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