Transperineal ultrasound imaging of the pelvic floor muscles in women with pelvic floor dysfunction symptoms: A cross-sectional study

Abstract

Abstract Objective Transperineal ultrasound (TPUS) assessment of the pelvic floor muscle (morphological and dynamic function) in women with pelvic floor dysfunction symptoms. Study design A cross-section study, 73 women complaining of any of the pelvic floor disorder symptoms. Digital palpation of the puborectalis muscle using modified Oxford score grading system (MOS), 2 D and 3 D TPUS were done at rest, maximum contraction, and at valsalva. Levator ani defects, and/or avulsion were identified. Levator urethral gap (LUG) was measured. Ultrasound measurements were correlated to MOS, and presence of symptoms Results The mean percentage decrease in the antro posterior hiatal diameter (LHap) during contraction was significantly lower in women with UpfmC than those with NpfmC as assessed by MOS. A cut-off percentage decrease in LHap at contraction 2% predicted UpfmC; area under the curve 0.81, sensitivity 38.5%, specificity 81% and accuracy 50.6%. LUG was significantly longer in UpfmC. All cases of ultrasound diagnosed avulsion had an UpfmC by MOS. MOS had a strong positive correlation with percentage decrease LHap (contraction), and a strong negative correlation with the percentage increase in LHap (Valsalva), and LUG. Conclusion Ultrasound is clinically valuable, reasonable, allows morphological and dynamic evaluation of the function of PFM in women with pelvic floor dysfunction symptoms, and correlated well with MOS. LUG increased its validity for diagnosis of levator avulsion.