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OP23.03: Transperineal three‐dimensional ultrasound for the evaluation of levator ani pathology in urogynecological patients

Objectives: To evaluate the correlation between levator ultrasound morphology and pelvic floor pathology. Methods: A standardized pelvic floor questionnaire, physical examination (Baden–Walker classification), and multi-channel urodynamic testing (MMS, Holland). 2D, 3D and 4D transperineal ultrasound with a 4–8-MHz transabdominal probe, at rest, maximal Valsalva, and maximal contraction. Statistical analysis using SPSS software. Results: Forty-eight women were analyzed, median age 53 years. Levator avulsion defects were found in 79%, 19% right, 8% left and 52% bilaterally. In cases of bilateral avulsion, 28% had a larger avulsion defect on the right. Levator biometric indices are given in the Table. Levator ballooning (hiatal area ≥ 300 mm2) was observed in 4.5% of women at rest and 46.8% of women at maximal Valsalva. Levator ballooning at Valsalva correlated weakly with prolapse sensation (r = 0.32, 0.04 Fisher exact test) and voiding difficulty (r = 0.31, P = 0.04), but not with prolapse grading. Range and median of the ratios of the various biometric indices between maximum Valsalva and rest are shown in the Table. The Valsalva to rest ratio for the levator area at the genital hiatus was significantly larger than the other ratios. The Valsalva to rest ratio for area showed a weak correlation with prolapse sensation (r = 0.41, P = 0.01, Fisher exact test) and rectocele grading (r = 0.4, P = 0.012, Pearson Chi square). Conclusions: Levator ani defects are very common in patients with pelvic floor problems. The ratio between the levator areas at maximal Valsalva and at rest correlates with several prolapse symptoms and physical findings, and may represent the tissue elasticity of the levator ani. More research is needed to establish its significance to patient management and outcome.