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Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
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Does levator ani injury affect cystocele type?

V H Eisenberg1, V Chantarasorn, K L Shek

  • 1Department of Obstetrics and Gynecology, Sheba Medical Centre, Tel Hashomer, Israel. veredeis@bezeqint.net

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|June 26, 2010
PubMed
Summary

Green type III cystocele, characterized by an intact retrovesical angle (RVA), is linked to a higher prevalence of levator ani muscle avulsion, suggesting birth trauma as a cause. This finding challenges existing beliefs about cystocele origins.

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Area of Science:

  • Urogynecology
  • Pelvic Floor Disorders
  • Anatomical Imaging

Background:

  • Cystocele classification and its association with levator ani muscle injury are not fully understood.
  • Existing theories suggest central fascial defects cause certain cystocele types.

Purpose of the Study:

  • To investigate the prevalence of levator ani injury in different cystocele types defined by translabial ultrasound.
  • To explore potential pathophysiological mechanisms underlying cystocele development.

Main Methods:

  • Retrospective analysis of 222 women with physical examination, urodynamic testing, and 4D pelvic floor ultrasound.
  • Classification of cystoceles below the symphysis pubis into Green II (cystourethrocele) or Green III (intact RVA) using ultrasound parameters.
  • Blinded evaluation of prolapse, hiatal dimensions, and levator ani trauma.

Main Results:

  • Of 102 women with cystocele below the symphysis pubis, 63 had Green II and 39 had Green III.
  • Green III cystocele patients were older, had more severe prolapse, and higher rates of objective voiding dysfunction.
  • Green III cystoceles were associated with larger hiatal dimensions and significantly more levator ani muscle avulsions (69% vs. 35%).

Conclusions:

  • Cystocele with an intact retrovesical angle (Green III) is more likely associated with levator ani muscle avulsion.
  • This association suggests birth-related trauma as a primary cause for Green III cystoceles.
  • Findings contradict the belief that such cystoceles result from central, rather than lateral, fascial defects.