ENLARGEMENT OF THE LEVATOR HIATUS IN FEMALE PELVIC ORGAN PROLAPSE - CAUSE OR EFFECT

Aug 25, 2026

Uploaded by Finn

Retrospective observational analysis examined whether enlargement of the levator hiatus reflects a cause or an effect of female pelvic organ prolapse (FPOP). Women undergoing prolapse surgery between March 2005 and April 2009 were followed with translabial ultrasound before surgery and at 3–12 months postoperatively. Levator hiatal area was measured on Valsalva and during PFMC. Results showed a small but significant postoperative reduction in hiatal area on Valsalva, yet most patients still demonstrated abnormal ballooning, suggesting incomplete normalization after successful repair.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Hypothesis / aims of study

Study design, materials and methods

Results

Interpretation of results

46 Andrew B1 , Shek K L1 , Chantarasorn V1 , Dietz H P1 1. University of Sydney ENLARGEMENT OF THE LEVATOR HIATUS IN FEMALE PELVIC ORGAN PROLAPSE: CAUSE OR EFFECT? Hypothesis / aims of study Female pelvic organ prolapse (FPOP) is likely due to a combination of factors including genetic predisposition and environmental factors, with pregnancy and childbirth likely to be most important amongst the latter. FPOP is a common problem: in Australia, almost 1/5 of all women can expect to require prolapse surgery at least once in their lifetime(1) . The levator hiatus defines the ‘hernial portal’ through which female pelvic organ prolapse develops. The larger the hiatus, the greater the likelihood of FPOP(2) . It is however not clear whether excessive distensibility of the levator hiatus (‘ballooning’) is a cause or just the effect of FPOP. We undertook an observational study to determine whether patients after prolapse repair show changed levator biometry. If increased hiatal dimensions were an effect of prolapse, then successful prolapse correction should normalize hiatal dimensions. Study design, materials and methods This is a retrospective analysis of clinical and translabial ultrasound volume data of women who underwent prolapse surgery between March 05 and April 09. Clinical examination for prolapse grading was performed using the Pelvic Organ Prolapse Quantification System of the International Continence Society (ICS POP-Q) . Ultrasound volume data were acquired using a Voluson 730 expert system with RAB 8-4 Mhz transducer with the patient supine and after voiding (3) . Ultrasound postprocessing analysis was performed by the first author using the software 4D View versions 5.0- 7.0. We measured hiatal area as previously described, using the axial plane of minimal hiatal dimensions (2), in both pre- and postoperative volume datasets, the latter obtained in the context of our surgical audit program. In order to compare pre- and postoperative volume datasets that would maximise any effect of surgical cure, we analysed ultrasound volume data acquired at postoperative followup appointments between 3 and 12 months after the index surgery. Figure 1: Determination of hiatal dimensions by axial plane translabial ultrasound on Valsalva. A and C show midsagittal planes, B and D axial planes. A and B show the preoperative status, C and D the same planes 5 months after a successful defectspecific rectocele repair. Hiatal area is virtually unchanged (28.3 vs. 29.9 cm2). SP= symphysis pubis, B= bladder, R= rectocele/ rectal ampulla, A= anal canal, L= levator ani. The study was conducted in the context of a parent project that had been approved by the local institutional Human Research Ethics Committee. Statistical analysis was undertaken using the software Minitab v13 for PC (Mintab Inc. , State College, PA, USA) and SAS v9 .2 (SAS Institute Inc. , Cary, NC, USA. ) . Levator avulsion, type of surgery, mesh use, symptoms of recurrent prolapse and length of FU were tested in logistic regression as potential confounders. Results 94 women were identified as having undergone prolapse surgery during the inclusion period, and as having documented preoperative volume datasets that could be evaluated. Of those 94 patients, 83 had been seen between 3 and 12 months after their surgery, but in two cases the Valsalva volume dataset was missing, leaving 81. All subsequent analysis refers to those 81 patients. Mean age was 60.2 (SD± 11. 1) . All had given birth vaginally. Fifty-four had a previous hysterectomy, prolapse or incontinence surgery. 72 had symptoms of prolapse; nine womern with rectocele were operated on because of symptoms of obstructed defecation. All had a symptomatic prolapse which was a cystocele in 45, apical prolapse in 24, an enterocele in 19 and a rectocele in 58 cases. The following surgical procedures were performed: Transobturator sling (n=46), TVT (n=1), Anterior colporrhaphy (n=11), Anterior colporrhaphy w

FAQs

What was the study aim regarding the levator hiatus in FPOP?

The study aimed to determine whether enlarged levator hiatus dimensions after prolapse repair normalize after surgery, distinguishing whether “ballooning” is cause or effect.

How were levator hiatus measurements obtained?

Hiatal area was measured using axial plane translabial ultrasound volume data, assessed preoperatively and postoperatively, including during Valsalva and on PFMC.

What were the key findings after prolapse surgery?

Hiatal area on Valsalva decreased by about 10% and the change was statistically significant; however, most patients still showed abnormal distensibility (ballooning) postoperatively.

Aug 25, 2026

Uploaded by Finn