EP26.12: The levator‐urethra gap: What's normal for cranial aspects of the levator ani muscle?

The ‘levator- urethra gap’ (LUG) with a cut- off of 2.5cm for the three central slices on axial tomographic ultrasound imaging (TUI) can help assessment of levator defect. Levator avulsion is not an all or nothing phenomenon and that muscle injury involving the upper slices also matters. We aimed to determine the cut-off for the upper three slices by using the mean+2SD in a vaginally nulliparous population. A retrospective analysis of data of vaginally nulliparae obtained in a tertiary urogynecological centre between 1/2012 to 2/2020. All had undergone a questionnaire, POPQ examination and TLUS. Postprocessing of archived ultrasound data was performed on a desktop PC. LUGs were measured for the three cranial slices on both sides on TUI (see figure 1). Data sets of 148 (50%) women with exclusive Caesarean births and 149 (50%) nulliparae were analysed. 69 (23%) presented with POP. Mean age was 51 years (17-89), 108 (36%) had clinically significant POP, it was 89 (30%) on TLUS. Overall mean LUG was 1.9cm (SD 0.319) and the mean+2SD was 2.54cm. Mean and maximum LUG of individual patient were significantly associated with objective and subjective POP (see table1). In a vaginally nulliparous population the mean LUG+2SD for the three cranial slices on TUI was 2.54cm. This is near- identical to the cut off suggested for the three central slices on TUI. This implies that a standard LUG cut-off of 2.5cm can be used for all six tomographic slices. Symptoms of POP (Yes/No) 1.98 vs 1.88 P=0.015 2.18 vs 2.08 P=0.023 Clinical significant POP (Yes/No) 2.00 vs 1.85 P < 0.001 2.20 vs 2.04 P < 0.001 Sonographic significant POP(Yes/No) 2.01 vs 1.86 P < 0.001 2.20 vs 2.06 P < 0.001 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.