EP26.08: Is a levator‐urethra gap cut‐off of 2.5cm for the three upper slices on TUI appropriate for assessment of the levator?

Levator avulsion is an important cause of POP and treatment failure. It is diagnosed using the three central slices on TUI. In equivocal cases the levator-urethra gap (LUG) with a cut-off of 2.5cm can be helpful. Recent data suggests that levator trauma is not an all or nothing phenomenon, minor forms of trauma and defects involving the upper three slices also matter. The cut-off of LUG for the upper three slices remains to be determined. The aim was to test the performance of a 2.5cm LUG cut-off in cranial slices on TUI for prediction of POP. Retrospective analysis of data obtained in a tertiary urogynecological centre between 6/2018 and 2/2020. All women had a POPQ examination and TLUS. Postprocessing of TLUS data was performed on a desktop PC. LUG, i.e. the distance between the centre of the urethra and the levator insertion was measured for the three upper slices bilaterally on TUI. ROC statistics were used to test associations between POP symptoms, clinical and sonographic POP on the one hand and LUG on the other. 519 data sets were analysed. Mean age was 57 years (18-94). 281 presented with POP (54%). 442 (85%) had clinically significant POP: a cystocele in 360 (69%), uterine prolapse in 165 (32%), rectocele in 334 (64%). On TLUS significant POP was found in 355 (68%). A full avulsion was diagnosed in 126 (24%) which was bilateral in 43 (8%). Considering just the upper three slices (519 × 6 = 3114assessments), LUG was associated with both symptoms and signs of POP (all<0.001). On ROC, the best performance of LUG was in prediction of significant sonographic POP. Figure 1 shows ROCs of Slices 6-8 for prediction of significant sonographic POP. By definition, the levator ani is wider both below and above the hiatus. In spite of this, associations between LUG and POP do not differ significantly for the upper 3 slices. The standard cut-off of 2.5cm seems to be appropriate for assessment of the upper three tomographic slices. 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.