The prevalence of major abnormalities of the levator ani in urogynaecological patients

Objectives While morphological abnormalities of the pubovisceral muscle have been described on magnetic resonance imaging (MRI), their relevance remains unclear. This study was designed to define prevalence and clinical significance of such abnormalities in urogynaecological patients. Design Prospective observational study. Setting Tertiary urogynaecological clinic. Population Three hundred and thirty-eight consecutive women referred for urodynamic assessment. Methods Participants underwent a clinical assessment, multichannel urodynamics and imaging with 3D translabial ultrasound. Blinded offline analysis was performed with the software 4D View (GE Kretztechnik, Zipf, Austria). Main outcome measures Major morphological abnormalities of the pubovisceral muscle. Results Defects of the pubovisceral muscle were found in 15.4% of parous women. They were exclusively anteromedial (uni- or bilateral), only occurred among women who had delivered vaginally and were associated with anterior and central compartment prolapse (all P < 0.001). There was no association with symptoms of bladder dysfunction or urodynamic findings. Conclusions Major morphological abnormalities of the pubovisceral muscle are common in parous urogynaecological patients. They are associated with prolapse of the anterior and central compartment, but not with symptoms of bladder dysfunction or urodynamic findings.