Prevalence of pubovisceral muscle avulsion in a general gynecology cohort: a computed tomography (CT) study.

Aims: To calculate the prevalence of pubovisceral muscle (PM) avulsion in a cohort of women presenting at a university hospital for non-urogynecological conditions.

Methods: Women with or without symptoms of PFD were studied in a tertiary referral urogynecology center between February and October 2010. Women were recruited from the Department of Radiology, where they were referred for a CT pelvis scan due to various pathologies. Assessment of participants included a detailed clinical interview, completion of King's Health and Prolapse-Quality of Life (P-QOL) questionnaires and spiral CT scan of the pelvis. Bilateral attachments of the PM to the pubic rami were identified in the plane of minimal hiatal dimensions, when present, and measurement of the levator symphysis gap (LSG) was taken in cases with PM complete detachment. Bivariate analysis between the PM maximum thickness and different obstetric variables was performed by using Spearman's correlation test (P < 0.05).

Results: One hundred ten women were included in the analysis. The overall prevalence of PM avulsion was 6.4% (7/110). In cases with confirmed avulsion, the levator sympysis gap (LSG) ranged from 17.30 to 25.40 mm. The left PM was found to be significantly thinner in parous women and in those with a history of prolonged second stage of labor.

Conclusions: The prevalence of pubovisceral muscle avulsion using CT scanning in a general gynecology cohort is 6.4%. Thinning of the pubovisceral muscle occurs with parity and protracted labor and is more prominent on the left portion of the muscle.