Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review

Siahkal, Shahla Faal; Iravani, Mina; Mohaghegh, Zeynab; Sharifipour, Foruzan; Zahedian, Maryam; Nasab, Maryam Beheshti

doi:10.1007/s00192-020-04639-0

Cited by 33Pelvic floor disorders treatmentsUterine Myomas and TreatmentsUrinary Bladder and Prostate Research

Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review

Siahkal, Shahla Faal, Iravani, Mina, Mohaghegh, Zeynab, Sharifipour, Foruzan, Zahedian, Maryam, Nasab, Maryam Beheshti·2021·International Urogynecology Journal

DOI 10.1007/s00192-020-04639-0

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Abstract

Background and hypothesis Pelvic organ prolapse (POP) is a very common and distressing problem that affects women's quality of life. This systematic review aimed to investigate the association of the dimensions of the genital hiatus and levator hiatus at rest and Valsalva with POP.Methods The Cochrane Library, PubMed, Scopus, Embase and Web of Science were searched on 25 April 2020. All data were analyzed using Review Manager 5.3.Results Of the 1288 papers reviewed, 21 (n = 5145: 2909 women with POP and 2236 controls) were considered for meta-analysis. Compared with the normal pelvic floor group, the urogenital hiatus size in the POP group was significantly higher at rest (mean difference: 0.49; 95% CI: [0.43, 0.55], P < 0.00001) and at Valsalva (mean difference: 0.79; 95% CI: [0.70, 0.89], P < 0.00001). Also, the levator ani hiatus size in the POP group was significantly higher at rest (mean difference: 0.52, 95% CI: [0.25, 0.78], P < 0.0001) and at Valsalva (mean difference: 1.01; 95% CI: [0.73,1.28], P < 0.00001) compared with that in the normal pelvic floor group.Conclusion This systematic review showed that the sizes of the urogenital hiatus and levator ani hiatus and area of the levator hiatus in the POP group were significantly higher than those in the normal pelvic floor groups in both positions (rest or Valsalva maneuver). Also, in the POP group, the levator hiatus length at rest was significantly lower than that in the Valsalva maneuver.

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Crossref · 10.1007/s00192-020-04639-0

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Women with POP have pelvic floor muscle impairment.
“Women with POP have shown to have PFM impairment [4, 6, 8–16]”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [10]
The association between a decrease in levator plate angle, an increase in levator hiatus area and presence of POP has been confirmed in several studies.
“The association between a decrease in levator plate angle, increase in levator hiatus area and presence of POP has been confirmed in several studies [5–13].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [10]
The dimensions of the levator hiatus are greater both at rest and during Valsalva maneuver in women with POP compared to women without POP.
“the dimensions of the levator hiatus are greater both at rest and during Valsalva maneuver in women with POP compared to women without POP.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [10]

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Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse*1
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5B: On the relationship between the urogenital and levator hiatuses and pelvic organ prolapse
Nandikanti, L., Xie, B., Ashton‐Miller, J. A., & DeLancey, J. O. L. (2017) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2016.12.157
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Pelvic Organ Prolapse Stage and the Relationship to Genital Hiatus and Perineal Body Measurements
Dunivan, G. C., Lyons, K. E., Jeppson, P. C., Ninivaggio, C. S., Komesu, Y. M., Alba, F. M., & Rogers, R. G. (2016) · Urogynecology · doi:10.1097/spv.0000000000000323 · Cited by 43 · see citing works

Authors: Siahkal, S. F., Iravani, M., Mohaghegh, Z., Sharifipour, F., Zahedian, M., & Nasab, M. B.
Affiliations: Islamic Azad University, Tehran (IR)
Ahvaz Jundishapur University of Medical Sciences (IR)
University of Tehran (IR)
Kermanshah University of Medical Sciences (IR)
Corresponding author: Iravani, Mina
ORCID: Siahkal, Shahla Faal
Iravani, Mina
Mohaghegh, Zeynab
Sharifipour, Foruzan
Zahedian, Maryam
Venue: International Urogynecology Journal
Publisher: Springer Science and Business Media LLC
Published: 2021-02-01
Volume: 32
Issue: 8
Pages: 2095-2109
ISSN: 0937-3462 (ISSN-L)
1433-3023
DOI: 10.1007/s00192-020-04639-0
OpenAlex: W3126535255
Cited by: 33
References: 51
Citations by year: 2026: 6 · 2025: 12 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 2
FWCI: 0.61
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: International Urogynecology Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Keywords: pelvic organ prolapse, genital hiatus, levator hiatus, levator ani muscle, urogenital hiatus, pelvic floor, Valsalva maneuver, women's health
MeSH terms: Female, Genitalia, Humans, Quality of Life, Ultrasonography, Valsalva Maneuver, Imaging, Three-Dimensional, Pelvic Organ Prolapse

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Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review

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