Correlating signs and symptoms with pubovisceral muscle avulsions on magnetic resonance imaging

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• 作者：Karin Lammers ; MD^a ; ^b ; ^{K.Lammers@obgyn.umcn.nl} ; Jurgen Jacobus Fü ; tterer ; MD ; PhD^b ; Joanna Inthout ; MSc^c ; Mathias Prokop ; MD ; PhD^b ; Mark Ewout Vierhout ; MD ; PhD^a ; Kirsten Birgit Kluivers ; MD ; PhD^a
• 关键词：levator ani muscle ; magnetic resonance imaging ; muscle avulsion ; pelvic organ prolapse ; pubovisceral muscle
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：208
• 期：2
• 页码：148.e1-148.e7
• 全文大小：555 K

文摘

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Objective

We sought to correlate signs and symptoms of pelvic organ prolapse (POP) with pubovisceral muscle avulsions on magnetic resonance imaging (MRI).

Study Design

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).

Conclusion

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.