Senior Resident ESI-PGIMSR, Delhi, India New York, New York, United States
Objectives: Estimating the diagnostic accuracy of translabial ultrasonography of the pelvic floor as compared to magnetic resonance imaging for diagnosing and grading levator defects in women with pelvic organ prolapse
Methods: This was an observational cross-sectional study of women presenting with 2nd-degree and above pelvic organ prolapse. Clinical POPQ grading, translabial ultrasonography, and pelvic Magnetic resonance imaging were done for all included women. Levator ani muscle defect or avulsion injury on both sides was graded, following which a score was assigned (0 – for no damage, 1- less than half muscle belly damage, 2-more than half muscle belly damage, 3 for complete avulsion) and classified into major (4-6) and minor (1-3) defects. This score was compared and analyzed using translabial ultrasound and pelvic magnetic resonance imaging.
Results: A group of 61 women were studied; all underwent a clinical exam and imaging of both ultrasonographical and magnetic resonance of the pelvic floor. The mean age of the study population was 53 years; 96% were above the age of 41 years, of which 77% women were postmenopausal. Parity among the studied women varied from- 2 (28%), 3-4(54%), and more than 4(28%). Stage of prolapse was graded by POPQ; 80% of women had stage 3 prolapse in the anterior compartment. Levator ani defect was graded major in 18% of women on translabial ultrasound, while 19.7% of women had major defects identified on MRI. On comparison between both modalities, a p-value of 0.56 was achieved, signifying no significant difference; hence, the results achieved on both diagnostic modalities were comparable and agreeable.
Conclusions: Translabial ultrasonography and magnetic resonance imaging of the pelvic floor have good agreeability, and hence, ultrasound can be used to diagnose and grade levator ani defects in patients with POP. Translabial ultrasonography can be used as a diagnostic modality in detecting levator ani defects in patients with POP, and this information can help tailor surgical treatment to reduce reoccurrence after primary surgical repair.
