Does levator avulsion cause distension of the genital hiatus and perineal body?

Introduction and hypothesis Levator avulsion is associated with prolapse and prolapse recurrence after reconstructive surgery. We set out to determine whether clinical measurement of the genital hiatus and the perineal body (gh + pb) on maximum Valsalva can predict levator avulsion. Methods A total of 295 women attending a tertiary referral service underwent 4D translabial ultrasound imaging and clinical examination using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification system (POP-Q). Analysis of ultrasound data sets for levator avulsion was performed using tomographic ultrasound imaging. The predictive performance of gh + pb for avulsion was tested using receiver-operating characteristic curves. Results Optimal sensitivity [70 %, 95 % confidence interval (CI) 59-79 %] and specificity (70 %, 95 % CI 66-72 %) were achieved with a cut-off of 8.5 cm for gh + pb. Conclusions A gh + pb measurement ≥ 8.5 cm may help to identify women with levator avulsion who are at increased risk of prolapse recurrence.