Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound.
OBJECTIVE
Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse (FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion.


METHODS
We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle.


RESULTS
Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P<0.001). Lesser degrees of trauma ('partial avulsion') were not associated with symptoms or signs of pelvic floor dysfunction.


CONCLUSIONS
Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance.
Sydney Medical School Nepean, Penrith, Australia. hpdietz@bigpond.com
Hans Peter
HP
Dietz
Maria Jose
MJ
Bernardo
Adrienne
A
Kirby
Ka Lai
KL
Shek
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008875:Middle Aged; D009135:Muscular Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000293:injuries*; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000209:etiology; D053202:Urinary Incontinence, Urge / Q000209:etiology; D055815:Young Adult