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Updated: Oct 19, 2025

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Levator-Urethra Gap: Normative Data in a Nonpregnant Nulliparous Population.

W Thomas Gregory, Meagan Cramer, Amanda Holland1

  • 1Department of Obstetrics and Gynecology, OHSU, Portland, OR.

Female Pelvic Medicine & Reconstructive Surgery
|September 17, 2021
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Summary

This study established normative levator-urethra gap (LUG) measurements in nulliparous women. These findings provide a standard for assessing levator ani injury using MRI or ultrasound.

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Area of Science:

  • Pelvic floor imaging and diagnostics
  • Female pelvic medicine and reconstructive surgery
  • Anatomical variation and measurement standards

Background:

  • The levator ani muscle is crucial for pelvic floor support.
  • Assessing levator ani injury often relies on indirect measurements.
  • Establishing normative data is essential for accurate clinical assessment.

Purpose of the Study:

  • To determine the normative range of the levator-urethra gap (LUG) in nonpregnant, nulliparous women.
  • To establish a reference standard for evaluating levator ani muscle injury or avulsion.
  • To compare LUG measurements obtained via MRI and 3D transperineal ultrasound.

Main Methods:

  • High-resolution magnetic resonance imaging (MRI) and 3D transperineal ultrasonography were performed.
  • The levator-urethra gap (LUG) was measured in the plane of minimal hiatal dimensions.
  • Measurements were taken on both right and left sides across three contiguous image slices.

Main Results:

  • 134 MRIs and 70 ultrasounds were evaluable from 135 participants.
  • The 99th percentile for LUG was ≤2.39 cm for both MRI and ultrasound.
  • Putative injury thresholds were identified as low as 2.1 cm (MRI) and 2.25 cm (ultrasound).

Conclusions:

  • The study established normative levator-urethra gap (LUG) values for nulliparous women.
  • These normative ranges can serve as a standard for diagnosing levator ani injury.
  • Specific LUG thresholds suggestive of injury were identified for both MRI and ultrasound modalities.