Levator plate angle in women with pelvic organ prolapse compared to women with normal support using dynamic MR imaging
Open accessAbstract
Objective The purpose of this study was to determine whether the levator plate is (1) horizontal in women with normal support, (2) different between women with and without prolapse, (3) related to levator hiatus and perineal body descent.Study design Cohorts of cases with prolapse at least 1 cm below the hymen and normal controls with all points 1 cm or more above the hymen were prospectively enrolled in a study of pelvic organ support to be of similar age, race, and parity. Subjects underwent supine midsagittal dynamic magnetic resonance imaging (MRI) during Valsalva. Levator plate angle (LPA) was measured relative to a horizontal reference line. Levator hiatus length (LH) and perineal body location (PB) were also measured. Student t tests and Pearson correlation coefficients (r) were performed.Results Sixty-eight controls and 74 cases were analyzed. During Valsalva, controls had a mean LPA of 44.3 degrees . Cases, compared to controls, had 9.1 degrees (21%) more caudally directed LPA (53.4 degrees vs 44.3 degrees , P < .01), 15% larger LH length (7.8 cm vs 6.8 cm, P < .01), and 24% more caudal PB location (6.8 cm vs 5.5 cm, P < .01). Increases in LPA were correlated with increased LH length (r = 0.42, P < .0001) and PB location (r =.51, P < .0001).Conclusion The measured levator plate angle in women with normal support is 44.3 degrees . During Valsalva, women with prolapse have a modest (9.1 degrees) though statistically greater levator plate angle compared to controls. This larger angle showed moderate correlation with larger levator hiatus length and greater displacement of the perineal body in women with prolapse compared to controls.
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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 [9]
The Results (Table III, peak Valsalva) report a larger—not smaller—levator plate angle in women with prolapse than in controls (53.4° versus 44.3°). The paper also reports a larger levator hiatus length, but it measured length rather than area. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredWomen 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 [9]
The Results (Comment; page unavailable) report a more vertical levator plate angle, a larger levator hiatus, and greater perineal-body displacement in women with POP than in controls. The authors interpret the angle as a possible indicator of levator ani damage, but they do not directly demonstrate pelvic floor muscle impairment and note that some women with prolapse have intact muscles. (LLM, conf=0.82)
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- Authors
- Hsu, Y., Summers, A., Hussain, H. K., Guire, K. E., & Delancey, J. O. L.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Hsu, Yvonne
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2006-05
- Volume
- 194
- Issue
- 5
- Pages
- 1427-1433
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC1479225
- OpenAlex
- W2059792587
- Cited by
- 72
- References
- 22
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 2 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 8 · 2014: 3 · 2013: 7 · 2012: 2
- FWCI
- 3.30
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038665, R01 HD38665, P50HD044406)
- 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, levator hiatus, pelvic floor support, dynamic MRI, Valsalva maneuver
- MeSH terms
- Abdominal Muscles, Aged, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Prospective Studies, Rest, Uterine Prolapse, Valsalva Maneuver, Cohort Studies, Observer Variation, Case-Control Studies, Pelvic Floor
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