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Evaluation of levator ani with no defect on elastography in women with POP.

OBJECTIVE
It is difficult to evaluate the function of levator ani with no defect encountered in routine practice. Elastography is a new adjunct to real-time ultrasound imaging that overlays traditional B-mode imaging with a color graphic representation of tissue elasticity. The aim of this study is to specifically evaluate the function of levator ani with no defect by ES (elastography).


METHODS
This was a prospective, observational study. All patients were examined by MRI and the cases with levator ani defect were excluded. The included cases underwent conventional translabial ultrasound, and then ultrasound ES. A little levator ani were biopsied for immunohistochemistry check in the patients who underwent surgery.


RESULTS
Of the 52 cases with no levator ani defects, 22 had an elastography score of 1, 20 had a score of 2, 8 had a score of 3 and 2 had a score of 4 in levator ani. Cases of ES1 and ES2 were more than ES3 and ES4 (P = 0.004). The immunohistochemistry check indicated that 12 patients who underwent surgery showed weak expression and the other 4 patients showed moderate expression of collagen type I in levator ani, compared with 2 controls showing strong expressions.


CONCLUSIONS
Elastography can assess the change of elasticity function of levator ani though the structure has no defect which was detected by MRI and conventional ultrasound. And probably the change of function of levator ani was earlier than structure abnormity in POP.