OP24.12: Anal sphincter characteristics on 3D transperineal ultrasound in patients with pelvic floor problems

Abstract

Objectives: To evaluate possible sonographic indicators of levator ani tissue elasticity. Methods: In this prospective study, 140 consecutive patients with varied pelvic floor problems, underwent standard urogynecological evaluation supplemented by transperineal 3D ultrasound with a 4–8 MHz transabdominal probe (GE Kretz Voluson 730 system), at rest, best Valsalva, and best pelvic floor contraction. Blinded offline analysis was performed with 4D View (GE Kretz) software. The levator ani was assessed qualitatively for widening at Valsalva or narrowing during contraction (good, poor, none), as well as measured objectively by biometry (antero-posterior diameter, leftright diameter, circumference, and area). Levator avulsion defects were quantified during contraction at the minimal hiatal dimensions using Tomographic Ultrasound Imaging (TUI). Defects were scored 0–8 for each side with a maximum score of 16, in 8 slices, 2.5 mm apart. Results: The median age was 57 (range 24–80). Avulsion defects were found in 73.2% of women, with a median TUI score of 8. Levator ballooning (hiatal area ≥25 cm2) was observed in 71.4% at Valsalva. There was a significant correlation between the presence of ballooning on Valsalva and the extent of the avulsion seen on TUI (P = 0.001). The median Valsalva to rest ratio for the levator area at the genital hiatus was 1.4 and the median contraction to rest ratio was 0.9. A Valsalva to rest ratio for levator areas greater than 1.4 was in agreement with a subjective assessment of a good Valsalva manoeuvre (P = 0.001). A contraction to rest ratio for levator areas smaller than 0.95 was in agreement with a subjective assessment of a good contraction (P = 0.002). Conclusions: There is a good correlation between levator biometry and a subjective qualitative assessment of levator function. We suggest that a Valsalva to rest ratio for areas above 1.4 and a contraction to rest ratio for areas below 0.95 may be considered as markers of levator elasticity.