RT journal article
T1 Is the Presence of Levator Ani Muscle Avulsion Relevant for the Diagnosis of Uterine Prolapse?
A1 García-Mejido, José Antonio
A1 Martín-Martinez, Alicia
A1 García-Jimenez, Rocío
A1 González-Diaz, Enrique
A1 Núñez-Matas, María José
A1 Fernández Palacín, Fernando
A1 Carballo-Rastrilla, Sonia
A1 Fernández-Fernández, Camino
A1 Sainz Bueno, José Antonio
A2 Estadística e Investigación Operativa
K1 3D transperineal ultrasound
K1 pelvic floor
K1 pelvic organ prolapse
K1 uterine prolapse
AB Objective: To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis-uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP). Methods: This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic-uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion. Results: A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance-based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP. Conclusion: The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver.
PB John Wiley and Sons Ltd
SN 1550-9613
YR 2024
FD 2024
LK http://hdl.handle.net/10498/32285
UL http://hdl.handle.net/10498/32285
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 08-nov-2026