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Levator ani imaging (3D transperineal ultrasound)

Case contributed by Gamal Elsayed Abdelmoamen Fares
Diagnosis certain

Presentation

G2P2 normal vaginal deliveries, complaining of urgency and leakage of urine on straining.

Patient Data

Age: 40 years
Gender: Female

3D US of pelvic floor

ultrasound

These images show transperineal ultrasound assessment of levator ani for detection of any avulsion and assessment of levator ani hiatus.

Images 2 to 4 show changes in the distance between puborectalis and pubic symphysis known as levator ani hiatus in image 2, on kegel test it decreased as in image 4, while on straining it should be the same with no significant descent of bladder or urethral mobility as in image 3.

Case Discussion

These images show a dynamic study of the pelvic floor using 3D transperineal ultrasound in which a render line of the box of interest is applied at the level of puborectalis muscle using 3D option, tomographic ultrasound is then applied which distance between slides was 3 mm at 9 levels.

All images were normal and the patient was encouraged to change lifestyle after exclusion of urinary tract infection, in the form of a high protein diet and continuous performance of kegel exercise.

Demonstration of levator ani hiatus change in relation to kegel test acted like a biovisual mechanism of enhancing levator ani contraction. 

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