https://doi.org/10.4081/uij.2022.279

Comparison of levator hiatal area and anteroposterior length between pelvic organ prolapse subject with and without bulging symptoms

Vol. 34 No. 1 (2022)
Submitted: 22 October 2021
Accepted: 20 April 2022
Published: 3 May 2022
Pelvic organ prolapse, levator ani, levator hiatal area, anteroposterior length
Abstract Views: 510
PDF: 227
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Fernandi Moegni
fernandi71@ui.ac.id
https://orcid.org/0000-0001-9537-4256
Reconstruction Aesthetic Urogynecology Division, Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Anthonyus Natanael
Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Tyas Priyatini
Reconstruction Aesthetic Urogynecology Division, Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Alfa Putri Meutia
Reconstruction Aesthetic Urogynecology Division, Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Budi Iman Santoso
Reconstruction Aesthetic Urogynecology Division, Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Pelvic Organ Prolapse (POP) is defined as the descent of the pelvic viscera (uterus, bladder, urethra, and rectum) from its normal position. There are different stages of POP starting from early asymptomatic until late obvious symptomatic stages. Levator Anal Muscle (LAM) which plays an important part in POP pathogenesis, showed that there was difference in Levator Hiatal (LH) area and anteroposterior length on every grade of POP. It is important to determine early diagnose of asymptomatic POP clinically by anteroposterior length measurement, and determined its relation with LH area measurement using Ultrasound (US) imaging. To compare LH area and anteroposterior length between POP subject with and without bulging symptom. A cross-sectional study was conducted among women diagnosed as POP with and without bulging symptom in a Urogynecology Clinic between November 2019 to March 2021. Patients were examined using the POP-Q system and 3D/4D imaging of the LH area using Voluson type systems. Data were analyzed to compare LH area and anteroposterior length between groups. A total of 109 subjects were included in this study. There was a significance difference in LH area (28.9+5.59 cm2 vs 19.6+4.63 cm2, p < 0.05 during valsalva maneuver, 15.2+4.08 cm2 vs 12.5+3.15 cm2, p <0.05 during contraction) and anteroposterior length (8.6+1.06 cm, vs 6.8+1.13 cm, p<0.05) between groups with and without bulge symptom. LH area and anteroposterior length cut-off to differentiate between subject with and without bulging symptom was respectively 25,1 cm2 [sensitivity 84,6%, specificity 92,9%, AUC 0,925 (0,864-0,986)] and 7,75 cm [sensitivity 87,2%, specificity 77,1%, AUC 0,859 (0,787-0,932)]. In patient without bulging symptom there was a significant difference of anteroposterior length between prolapse stage 1, 2, and 3. Post hoc analysis with Tukey test showed a significant difference of anteroposterior length only between grade 0 and 2, and grade 1 and 2. There was a significant difference in LH area and anteroposterior length between groups with and without bulging symptom. LH area cut-off at 25,1 cm2, anteroposterior length cut-off at 7.75 cm showed good sensitivity and specificity to differentiate between 2 groups.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Purwara BH, Armawan E, Sasotya RS, Achmad ED. Faktor Risiko Penderita Prolapsus Organ Panggul terhadap Hiatus Genitalis, Panjang Total Vagina, dan Perineal Body. [Risk factors for Pelvic Organ Prolapse patients in Genital Hiatal, Total Vaginal Length and Perineal Body.][Article in Indonesian] Maj Kedokt Bdg 2014;46:57–60. DOI: https://doi.org/10.15395/mkb.v46n1.229
Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 2005;25:580–5. DOI: https://doi.org/10.1002/uog.1899
Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in US Women: 2010 to 2050. Obstet Gynecol 2009;114:1278–83. DOI: https://doi.org/10.1097/AOG.0b013e3181c2ce96
Ghetti C, Gregory WT, Edwards SR, et al. Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol 2005;193:53–7. DOI: https://doi.org/10.1016/j.ajog.2004.12.004
Dietz HP, Shek C, De Leon J, Steensma AB. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 2008;31:676–80. DOI: https://doi.org/10.1002/uog.5355
Gerges B, Kamisan Atan I, Shek KL, Dietz HP. How to determine “ballooning” of the levator hiatus on clinical examination: a retrospective observational study. Int Urogynecology J 2013;24:1933–7. DOI: https://doi.org/10.1007/s00192-013-2119-6
Sayko S, Kurniawati E, Lestari P. Age as the risk factor that affected the increased degree of uterine prolapse. Biomolec Health Sci J 2018;1:20-4. DOI: https://doi.org/10.20473/bhsj.v1i1.8210
Nygaard IE, Shaw JM, Bardsley T, Egger MJ. Lifetime physical activity and pelvic organ prolapse in middle-aged women. Am J Obstet Gynecol 2014;210:477.e1-477.e12. DOI: https://doi.org/10.1016/j.ajog.2014.01.035
Tegerstedt G, Miedel A, Maehle-Schmidt M, et al. Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol 2006;194:75-81. DOI: https://doi.org/10.1016/j.ajog.2005.06.086
Kusuma IGY, Putra IGM, Megadhana IW, et al. Characteristic of patients with pelvic organ prolapse in obstetric and gynecologic outpatient clinic in Sanglah Hospital, Bali, Indonesia from January 2014 to December 2015. Bali Medical Journal 2017;6:76. DOI: https://doi.org/10.15562/bmj.v6i1.390
Saimin J, Hafizah I, Indriyani N, et al. Uterine prolapse in postmenopausal women in the coastal areas: prolaps uteri pada perempuan postmenopause di Daerah Pesisir. Indones J Obstet Gynecol 2020;8:203–6. DOI: https://doi.org/10.32771/inajog.v8i4.1349
Martinho N, Friedman T, Turel F, et al. Birthweight and pelvic floor trauma after vaginal childbirth. Int Urogynecol J 2019;30:985-990. DOI: https://doi.org/10.1007/s00192-019-03882-4
Valsky DV, Lipschuetz M, Bord A, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 2009;201:91.e1-7. DOI: https://doi.org/10.1016/j.ajog.2009.03.028
Digesu GA, Chaliha C, Salvatore S, et al. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG Int J Obstet Gynaecol 2005;112:971–6. DOI: https://doi.org/10.1111/j.1471-0528.2005.00568.x
Dunivan GC, Lyons KE, Jeppson PC, et al. Pelvic organ prolapse stage and the relationship to genital hiatus and perineal body measurements. Female Pelvic Med Reconstr Surg 2016;22:497–500. DOI: https://doi.org/10.1097/SPV.0000000000000323
Khunda A, Shek KL, Dietz HP. Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol 2012;206:246.e1-246.e4. DOI: https://doi.org/10.1016/j.ajog.2011.10.876
Handa VL, Roem J, Blomquist JL, et al. Pelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength. Am J Obstet Gynecol 2019;221:41.e1-41.e7. DOI: https://doi.org/10.1016/j.ajog.2019.03.004
Andrew BP, Shek KL, Chantarasorn V, Dietz HP. Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect? Aust N Z J Obstet Gynaecol 2013;53:74–8. DOI: https://doi.org/10.1111/ajo.12026
Kustarto KW, Moegni F. The role of genital hiatus (Gh), perineal body (Pb), summation (Gh+Pb) of POP-Q examination in maximum levator hiatal area of women with symptomatic pelvic organ prolapse. Indones J Obstet Gynecol 2019;130–40. DOI: https://doi.org/10.32771/inajog.v7i2.540
Volloyhaug I, Wong V, Shek KL, Dietz HP. Does levator avulsion cause distension of the genital hiatus and perineal body? Int Urogynecology J 2013;24:1161–5. DOI: https://doi.org/10.1007/s00192-012-1993-7

How to Cite

Moegni, F., Natanael, A., Priyatini, T., Meutia, A. P., & Santoso, B. I. (2022). Comparison of levator hiatal area and anteroposterior length between pelvic organ prolapse subject with and without bulging symptoms. Urogynaecologia, 34(1). https://doi.org/10.4081/uij.2022.279

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.

An Open Access Publication is one that meets the following two conditions:

  1. the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.
  2. a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.