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Is There a Difference in Hiatal Area on Straining Between Type I and II Levator Avulsions?
Ka-Wing Lau1, Hans Peter Dietz2, Ka Lai Shek3
1Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China. martinkwlau@hotmail.com.
International Urogynecology Journal
|April 20, 2026
Summary
Levator avulsion type, whether connected to the pelvic sidewall or not, does not significantly impact hiatal area during straining. This finding is based on 4D pelvic floor ultrasound analysis in women with pelvic floor dysfunction.
Area of Science:
- Urogynecology
- Pelvic Floor Imaging
- Female Pelvic Medicine
Background:
- Levator avulsions are classified into type I (preserving sidewall connection) and type II (no sidewall connection).
- The impact of avulsion type on hiatal dimensions during straining is not well understood.
Purpose of the Study:
- To evaluate if levator avulsion type (I vs. II) influences hiatal area on straining.
- To analyze the relationship between levator avulsion morphology and pelvic floor dimensions.
Main Methods:
- Retrospective observational study of 524 women undergoing 4D pelvic floor ultrasound.
- Standardized assessment of hiatal area on maximum straining and levator avulsion type (I or II).
- High inter-rater reliability (ICC=0.872) for hiatal area measurements.
Main Results:
- Mean hiatal area on straining was 26.9 cm².
- Type I avulsion observed in 15.3% and type II in 6.5% of women.
- No significant difference in mean hiatal area on straining between type I (32.6 cm²) and type II (33.48 cm²) avulsions (P=0.6).
Conclusions:
- Levator avulsion type does not appear to be a significant determinant of hiatal area on straining.
- Further research may explore other factors influencing hiatal dimensions in pelvic floor disorders.
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