Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse*1
Abstract
OBJECTIVE: Compare urogenital hiatus size in normal women and women with pelvic organ prolapse. METHODS: The sagittal and transverse urogenital hiatus diameters were measured and hiatus area calculated in 300 women whose support was scored using a modified Baden system. RESULTS: In women with normal support and without prior surgery, hiatus area was 5.4 cm2 (+/-1.71 standard deviation [SD], n = 197). In women with uncorrected clinical prolapse (grade 2-3), the area of the hiatus was enlarged (9.6 cm2 +/- 3.97, n = 34, P < .05) and became larger with progressive prolapse (grade 0, 5.4 cm2 +/- 1.71, n = 197; grade 1, 7.3 cm2 +/- 1.91, n = 27; grade 2, 8.3 cm2 +/- 2.45, n = 18; grade 3, 11.0 cm2 +/- 4.90, n = 16). When matched for age and parity, prolapse patients had a larger hiatus than normal women. Women with recurrent prolapse had a larger hiatus than cured women (13.3 cm2 +/- 3.86, n = 8 compared with 8.1 cm2 +/- 2.44, n = 16, P < .05) or women with recurrence after one operation (8.9 cm2 +/- 1.77, n = 18, P < .05). Hiatus size in patients surgically cured (8.3 cm2 +/- 2.44, n = 16) did not return to normal (5.4 cm2 +/- 1.71, n = 197, P < .05). Increasing area of the hiatus was correlated with an increase in anterior-posterior diameter (r2 = 0.9, P < .05), was less attributable to increased transverse diameter (r2 = 0.6, P < .05), and was not related to thickness of the perineal body (r2 = 0.0, P > .05). CONCLUSION: Increasing pelvic organ prolapse is associated with increasing urogenital hiatus size; the hiatus is larger after several failed operations than after successful surgery or single failure.
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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].”
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- Authors
- DELANCEY, J.
- Affiliations
- University of Michigan (US)
- Corresponding author
- DELANCEY, J
- Venue
- Obstetrics & Gynecology
- Published
- 1998-03
- Volume
- 91
- Issue
- 3
- Pages
- 364-368
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W1968177687
- Cited by
- 224
- References
- 7
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 10 · 2021: 10 · 2020: 11 · 2019: 8 · 2018: 8 · 2017: 4 · 2016: 8 · 2015: 10 · 2014: 11 · 2013: 7 · 2012: 5
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk047516-03)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK 47516)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- pelvic organ prolapse, levator ani muscle, urogenital hiatus, pelvic floor support, prolapse recurrence, perineal body, pelvic floor dysfunction, women's health, pelvic organ prolapse surgery
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anal Canal, Female, Humans, Middle Aged, Muscles, Perineum, Prolapse, Reference Values, Pelvic Floor
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