title: Diagnosing pubovisceral avulsions: a systematic review of the clinical relevance of a prevalent anatomical defect.
abstract: The aims of this systematic literature review were to assess whether the detection of pubovisceral avulsions using magnetic resonance (MR) imaging or perineal ultrasonography was clinically relevant in women with pelvic floor dysfunction and to evaluate the relation with anatomy, symptoms, and recurrence after surgery. We performed a systematic literature review using three bibliographical databases (PubMed, Embase, and CINAHL) as data sources. Clinical studies were included in which pubovisceral avulsions were studied in relation to pelvic organ prolapse (POP) stage, pelvic floor symptoms, and/or recurrence of POP after surgery. Ultimately, 21 studies met the inclusion criteria. POP stage and recurrence of POP after surgery were strongly associated with pubovisceral avulsions. Contradictory results were found regarding the relation between pubovisceral avulsions and urinary symptoms and symptoms of anorectal dysfunction. Pubovisceral avulsions, as diagnosed by MR imaging or perineal ultrasonography, are associated with higher stages of POP and recurrence of POP after surgery.
authors.affiliation: Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. K.Lammers@obgyn.umcn.nl
authors.forename: Karin
authors.initials: K
authors.lastname: Lammers
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Mathias
authors.initials: M
authors.lastname: Prokop
authors.forename: Mark E
authors.initials: ME
authors.lastname: Vierhout
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009130:Muscle, Smooth / Q000293:injuries*; D017773:Pelvic Floor / Q000293:injuries / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000209:etiology*; D010502:Perineum / Q000473:pathology / Q000503:physiopathology; D012002:Rectal Diseases / Q000175:diagnosis / Q000209:etiology; D012421:Rupture