P32.03: Area of urogenital hiatus and severity of genital prolapse: is there any correlation?

Abstract

The injury of the levator ani could be produced as a macrotrauma, an avulsion injury on ultrasound or as a microtrauma, with a hiatal distension of the levator on the ultrasound. The abnormal distensibility with Valsalva maneuver it's an independent prognostic factor for the development of a genital prolapse and the recurrence after the surgery. The objective of our study is to analyze if there's any correlation between the overdistension of the urogenital hiatus in Valsalva, measured by 4D ultrasound, and the degree of the genital prolapse. A retrospective analysis of clinical and ultrasound data of patients with genital prolapse in our hospital in 2008. ANOVA test was performed to study the correlation between the degree of genital prolapse and the ecographic hiatal area. Normal distribution of the variable area of the urogenital hiatus is checked using Kolmogorov-Smirnov test. We analyzed 215 patients whose degree of genital prolapse was classified based on Baden-Walker test from 0 to 4. The average area of the urogenital hiatus is 33,39cm2. If we calculate the mean of the hiatal area for each degree of genital prolapse and apply the ANOVA test, we note that this increases with increasing degree of prolapse, although the difference between categories 2 and 3 is small. The linear component of the test shows that there are significative differences between the groups and it means that the severity of prolapse increases the hiatal area linearly. With the ANOVA analysis it can't be obtained among which groups the difference is statistically significative. When we use the Tukey's test for multiple comparison, we note that the only statistically significative differences are among the group without genital prolapse and the groups with degree 2 or more. There are some discordances between symptoms and the prolapse degree objectified during clinical examination. The ultrasound could help us to discriminate which patients with an increased area of hiatus may benefit from surgery.