title: The time factor in the assessment of prolapse and levator ballooning.
abstract: OBJECTIVE
  The goal of the study was to define the time needed to obtain maximal organ descent and hiatal distension during Valsalva measured by transperineal ultrasound. Secondarily, we aimed to describe the timing of these events in relationship to each other.
  
  
  METHODS
  We undertook a retrospective review of the stored ultrasound volume datasets of 50 patients with pelvic organ prolapse. Data on organ descent and hiatal distension were obtained in 10 volumes from rest to maximal Valsalva.
  
  
  RESULTS
  On average, a Valsalva maneuver lasted 9.4 s (range 5 to 18). It took patients on average about six volumes (approximately 5-6 s) to reach 80% of maximum organ descent. The time to maximum organ descent was 8.9 s and the time to maximum distension of the levator hiatus was 8.2 s, p = 0.031.
  
  
  CONCLUSIONS
  In order to obtain adequate assessment of pelvic organ prolapse, a Valsalva maneuver should last at least 6 s. Hiatal distension seems to precede pelvic organ descent.
authors: Department of Obstetrics and Gynecology, University of Texas Health Science Center, Houston, TX, USA. Francisco.J.Orejuela@uth.tmc.edu
authors: Francisco J
authors: FJ
authors: Orejuela
authors: Ka Lai
authors: KL
authors: Shek
authors: Hans Peter
authors: HP
authors: Dietz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000000981:diagnostic imaging*; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014636:Valsalva Maneuver