Conflict of interest: none.
Comparison between transperineal ultrasound and digital detection of levator ani trauma. Can we improve the odds?
Article first published online: 22 FEB 2013
© 2013 Wiley Periodicals, Inc.
Neurourology and Urodynamics
Volume 33, Issue 3, pages 307–311, March 2014
How to Cite
Kruger, J. A., Dietz, H. P., Budgett, S. C. and Dumoulin, C. L. (2014), Comparison between transperineal ultrasound and digital detection of levator ani trauma. Can we improve the odds?. Neurourol. Urodyn., 33: 307–311. doi: 10.1002/nau.22386
Mickey Karram led the peer-review process as the Associate Editor responsible for the paper.
This study was undertaken at the Physiotherapy Laboratory at the Montreal Geriatric Institute Research Centre for Pelvic floor muscle function in aging women.
- Issue published online: 15 MAR 2014
- Article first published online: 22 FEB 2013
- Manuscript Accepted: 24 JAN 2013
- Manuscript Received: 3 JUL 2012
- Fondation Institut de gériatrie de Montréal postdoctoral Fellowship Governor Program
- 3D ultrasound;
- digital assessment;
- levator ani muscle;
To investigate the predictive ability of four digital assessment parameters to detect levator ani (LA) muscle defects (avulsion injury) and compare these to transperineal tomographic ultrasound images.
This was an observational study imbedded in a larger quasi-experimental cohort study for women with urinary incontinence. Seventy-two women, ≥60 years who had attended or were going to attend physiotherapy for treatment of urinary incontinence, were included in the study. Inclusion criteria from the parent study were symptoms of stress, urge or both types of urinary incontinence. The predictive ability of the following digital parameters: direct palpation of a discontinuity of the LA muscle from insertion on the pubic ramus; palpation of the distance between the muscle insertion sites; palpation of LA strength; palpation of LA tone, were analyzed against findings from tomographic transperineal ultrasound images. Correlation between methods was measured using Cohen's kappa for each of the individual parameters.
Seventeen women (24%) presented with a complete or partial avulsion of the puborectalis muscle as diagnosed with tomographic ultrasound imaging. Nine women (13%) had complete avulsions, one of which was bilateral. The predictive ability of the digital assessment parameters varied from poor (k = 0.187, 95% CI [0.02–0.36]) to moderate (k = 0.569, 95% CI [0.31–0.83]). The new parameter of ‘width between insertion sites’ performed best.
Adding the parameter of “width between insertion sites” appears to enhance our ability to detect avulsion of the levator ani (LA) muscle by digital examination however it does not distinguish between unilateral or bilateral avulsion. Neurourol. Urodynam. 33:307–311, 2014. © 2013 Wiley Periodicals, Inc.