title: Correlating signs and symptoms with pubovisceral muscle avulsions on magnetic resonance imaging.
abstract: OBJECTIVE
  We sought to correlate signs and symptoms of pelvic organ prolapse (POP) with pubovisceral muscle avulsions on magnetic resonance imaging (MRI).
  
  
  METHODS
  In this retrospective cohort study of 189 women with recurrent POP or unexplained symptoms of pelvic floor dysfunction, we reviewed T2-weighted pelvic floor MRI and categorized defects as minor or major avulsion, or as no defect present. Outcomes were correlated to quality-of-life questionnaire scores and data on obstetric and surgical history, together with POP-Quantification (POP-Q) measurements. Multivariable ordinal logistic regression analysis with manual backward elimination was applied to calculate odds ratios (ORs).
  
  
  RESULTS
  Major pubovisceral avulsions were diagnosed in 83 (44%) women, minor avulsions in 49 (26%) women, while no defects were seen in 57 (30%) women. Women with a history of episiotomy or anterior vaginal wall reconstructive surgery had a higher OR for more severe pubovisceral muscle avulsions (adjusted OR, 3.77 and 3.29, respectively), as did women with symptoms of POP (OR, 1.01, per unit increase) or higher stage POP of the central vaginal compartment based on POP-Q measurement "C" (OR, 1.18). Women with symptoms of obstructive defecation were more likely to have no defect of the pubovisceral muscle on MRI (OR, 0.97, per unit increase).
  
  
  CONCLUSIONS
  The variables episiotomy, previous anterior vaginal wall reconstructive surgery, POP-Q measurement "C," and symptoms scored with the Urogenital Distress Inventory "genital prolapse" and Defecatory Distress Inventory "obstructive defecation" subscales are correlated with pubovisceral muscle avulsions on pelvic floor MRI.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands. K.Lammers@obgyn.umcn.nl
authors.forename: Karin
authors.initials: K
authors.lastname: Lammers
authors.forename: Jurgen Jacobus
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Joanna
authors.initials: J
authors.lastname: Inthout
authors.forename: Mathias
authors.initials: M
authors.lastname: Prokop
authors.forename: Mark Ewout
authors.initials: ME
authors.lastname: Vierhout
authors.forename: Kirsten Birgit
authors.initials: KB
authors.lastname: Kluivers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004841:Episiotomy; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009130:Muscle, Smooth / Q000293:injuries*; D016017:Odds Ratio; D017773:Pelvic Floor / Q000293:injuries*; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000209:etiology; D014621:Vagina / Q000601:surgery