Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect?
Article first published online: 31 DEC 2012
© 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 53, Issue 1, pages 74–78, February 2013
How to Cite
Andrew, B. P., Shek, K. L., Chantarasorn, V. and Dietz, H. P. (2013), Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect?. Australian and New Zealand Journal of Obstetrics and Gynaecology, 53: 74–78. doi: 10.1111/ajo.12026
- Issue published online: 14 FEB 2013
- Article first published online: 31 DEC 2012
- Manuscript Accepted: 1 NOV 2012
- Manuscript Received: 24 AUG 2012
- 3D ultrasound;
- female pelvic organ prolapse;
- levator hiatus;
- prolapse surgery
This study was undertaken to investigate whether female pelvic organ prolapse repair changes levator hiatal biometry.
Retrospective analysis of clinical and translabial ultrasound volume data of women who underwent prolapse surgery at a tertiary urogynaecological unit between March 2005 and April 2009. Data sets of 81 women were analysed who had undergone an interview, clinical assessment using POP-Q staging and 3D translabial ultrasound before and after prolapse surgery. Imaging data were obtained preoperatively and 3–12 months postoperatively to determine potential changes in levator hiatal dimensions. Type of surgery, mesh use, symptoms of recurrent prolapse, age, significant recurrent prolapse and length of follow-up were tested in linear regression as potential confounders.
The mean preoperative hiatal area on Valsalva was 31.9 cm2 (range 13.5–58.1 cm2, SD 10.0 cm2). Mean postoperative hiatal area on Valsalva was 28.9 cm2 (range 13.9–47.4 cm2; SD 7.3 cm2), which implies a significant reduction of 9% (P = 0.001). None of the tested potential confounders were found to be significantly associated with a perioperative change in hiatal area on Valsalva on linear regression analysis.
Surgery for female pelvic organ prolapse is associated with a small but significant reduction in hiatal area, but abnormal hiatal distensibility persists in most cases. This suggests that excessive hiatal distensibility is more likely the cause rather than the effect of prolapse.