Objective
The objective of the study was to determine whether genital hiatus (gh) and perineal
body (pb), measured using the pelvic organ prolapse quantification system of the International
Continence Society, are predictive of an abnormally distensible levator hiatus on
ultrasound and of objective prolapse and/or prolapse symptoms.
Study Design
The design of the study included datasets of 188 urogynecology patients assessed in
a cross-sectional retrospective study.
Results
Gh and pb, as well as gh plus pb, were strongly associated with symptoms and signs
of prolapse and with hiatal area on ultrasound. The sum of gh and pb was superior
in predictive performance to individual measures for symptoms (P < .001) and signs of prolapse (P < .001). Gh plus pb equaled the hiatal area on ultrasound (area under the curve,
0.886; 95% confidence interval, 0.828–0.945 vs 0.867; 95% confidence interval, 0.808–0.926)
for predicting objective prolapse. Optimal sensitivity (80%) and specificity (81%)
was reached with a cutoff of 7 cm for gh plus pb.
Conclusion
A cutoff of 7 cm for gh plus pb measured on Valsalva is proposed as a clinical definition
of excessive levator hiatal distensibility.
Key words
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Article info
Publication history
Published online: November 09, 2011
Accepted:
October 31,
2011
Received in revised form:
October 3,
2011
Received:
June 2,
2011
Footnotes
H.P.D. has in the past acted as a consultant for American Medical Systems, Minnetonka, MN; Continence Control Systems, Sydney, NSW, Australia; and Materna Inc., San Francisco, CA; accepted speaker's fees from General Electric Medical Ultrasound, Sydney, NSW, Australia; American Medical Systems; and Astellas, Tokyo, Japan; and has benefited from equipment loans provided by General Electric; Bruel and Kjaer, Gentofte, Denmark; and Toshiba, North Ryde, NSW, Australia. A. Z. and K. L. S. report no conflict of interest.
Cite this article as: Khunda A, Shek KL, Dietz HP. Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol 2012;206:246.e1-4.
Identification
Copyright
© 2012 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
