title: Does levator avulsion cause distension of the genital hiatus and perineal body?
abstract: OBJECTIVE
  Levator avulsion is associated with prolapse and prolapse recurrence after reconstructive surgery. We set out to determine whether clinical measurement of the genital hiatus and the perineal body (gh + pb) on maximum Valsalva can predict levator avulsion.
  
  
  METHODS
  A total of 295 women attending a tertiary referral service underwent 4D translabial ultrasound imaging and clinical examination using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification system (POP-Q). Analysis of ultrasound data sets for levator avulsion was performed using tomographic ultrasound imaging. The predictive performance of gh + pb for avulsion was tested using receiver-operating characteristic curves.
  
  
  RESULTS
  Optimal sensitivity [70%, 95% confidence interval (CI) 59-79%] and specificity (70%, 95% CI 66-72%) were achieved with a cut-off of 8.5 cm for gh + pb.
  
  
  CONCLUSIONS
  A gh + pb measurement ≥ 8.5 cm may help to identify women with levator avulsion who are at increased risk of prolapse recurrence.
authors.affiliation: Department of Gynaecology and Obstetrics, Trondheim University Hospital, PO Box 3250 Sluppen, 7006 Trondheim, Norway. ingridvolloyhaug@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: Volloyhaug
authors.forename: V
authors.initials: V
authors.lastname: Wong
authors.forename: K L
authors.initials: KL
authors.lastname: Shek
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000175:diagnosis*; D010502:Perineum / Q000473:pathology*; D011183:Postoperative Complications / Q000175:diagnosis*; D012372:ROC Curve; D014844:Vulva / Q000473:pathology*; D055815:Young Adult