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Ultrasound Obstet Gynecol. 2011 Jun;37(6):723-6. doi: 10.1002/uog.8969.

Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus.

Author information

1
Sydney Medical School Nepean, Nepean Hospital, Penrith, Australia. hpdietz@bigpond.com

Abstract

OBJECTIVE:

To determine the degree of levator hiatal asymmetry in women with unilateral avulsion of the puborectalis muscle in order to estimate the likely effect of successful reconstruction.

METHODS:

We reviewed datasets of women seen between May 2005 and January 2009 in a tertiary urogynecological unit. Archived ultrasound volume datasets were analyzed for hiatal dimensions and puborectalis muscle trauma in patients with unilateral avulsion.

RESULTS:

From 929 eligible datasets we identified 71 patients with isolated complete unilateral tears. Unilateral avulsion was associated with a significant increase in hiatal area (P ≤ 0.002). Relative to a hypothetical normal hiatus (intact hemi-area × 2), avulsion was associated with a larger hiatus on Valsalva maneuver (+2.1 cm(2) or 7%).

CONCLUSIONS:

Unilateral puborectalis muscle avulsion results in an asymmetric increase in the size of the levator hiatus. This increase is relatively minor, accounting for < 10% of hiatal area. Surgical repair of an avulsion may have only limited effects on hiatal dimensions.

PMID:
21351178
DOI:
10.1002/uog.8969
[Indexed for MEDLINE]
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