title: Levator ani defects in patients with stress urinary incontinence: three-dimensional endovaginal ultrasound assessment.
abstract: OBJECTIVE
  To determine the prevalence of levator ani (LA) muscle subdivision defects in patients with SUI using three-dimensional endovaginal ultrasound (3D EVUS).
  
  
  METHODS
  This is a prospective cohort study of 100 patients with pure or predominant urodynamic SUI who underwent 3D EVUS. The 3D cubes obtained were analyzed and the LA muscle was divided into three subgroups: the puboperinealis/puboanalis, the puborectalis, and the iliococcygeus/pubococcygeus. Each LA muscle subdivision was individually scored on each side (0: no defect, 1: ≤50 % muscle loss, 2: > 50 % muscle loss, and 3: total absence of the muscle) and a cumulative score, categorized as 0 (no defect), mild (total score 1-6), moderate (7-12), and severe (≥13) was calculated.
  
  
  RESULTS
  The number of women with no LA muscle defect or a mild defect was significantly higher than the number of those with a moderate or severe defect (p < 0.001). Apart from the small inverse relationship of the total puborectalis muscle score and the cumulative subdivision score with maximal urethral closure pressure (r value > -0.3; p < 0.05), the muscle defect scores were not found to correlate with urodynamic parameters (p > 0.05). Although all muscle subdivisions contributed to the overall LA muscle defect score, the association was strongest for the puborectalis component (r = 0.9; p < 0.001). The prevalence of the LA muscle defect in patients with intrinsic sphincter deficiency (ISD) was not significantly different from that in patients without ISD.
  
  
  CONCLUSIONS
  Patients with SUI have a higher prevalence of no or mild LA defect compared with a moderate or severe LA defect.
authors.affiliation: Centre for Urogynecology and Pelvic Health (C.U.P), New Delhi, India. aparnag.hegde@gmail.com.|Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA. aparnag.hegde@gmail.com.
authors.forename: Aparna
authors.initials: A
authors.lastname: Hegde
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas at Austin, Dell School of Medicine, Austin, Texas, USA.
authors.forename: Vivian C
authors.initials: VC
authors.lastname: Aguilar
authors.affiliation: Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D000368:Aged; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D017773:Pelvic Floor / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D059952:Pelvic Floor Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging* / Q000209:etiology; D014621:Vagina / Q000000981:diagnostic imaging
keywords: 3D endovaginal ultrasound; Levator ani muscle subdivision defect; Stress urinary incontinence