OP14.08: The role of three‐dimensional ultrasound in the evaluation of urogenital prolapse: a prospective study of 20 patients

Pelvic organ prolapse results from inadequate structural support, causing pelvic organs to protrude, with the pubococcygeus muscle delineating the critical levator hiatus. Pelvic organ prolapse results from inadequate structural support, causing pelvic organs to protrude, with the pubococcygeus muscle delineating the critical levator hiatus. This study assesses the efficacy of three-dimensional perineal ultrasonography in measuring the levator hiatus to guide surgical correction for pelvic organ prolapse. It also investigates pre- and postoperative quality of life, patient satisfaction, and ultrasonographic predictors of recurrence. A prospective longitudinal study was conducted at the Bizerte gynecology-obstetrics department from July 2023 to January 2024. Surgical interventions, including laparoscopic promontofixation or vaginal sacrospinofixation per Richter, were performed. Functional and clinical evaluations, along with pre- and postoperative 3D perineal ultrasound examinations, were conducted by the same clinician, assessing various parameters such as genital hiatus area, anus elevator muscle appearance, post-void residual, bladder wall thickness, cervical elongation, bladder neck position, and urethral mobility. Twenty patients participated. Surgery reduced the levator hiatus zone from an average of 24 to 18cm2 at rest. Simplified POP-Q measurements showed no significant change, except for points C or D. Hypertrophic cervical elongation (≥4cm) and levator ani avulsions remained predictors of recurrence. A larger hiatus area correlated with increased bladder neck mobility. Prolapse repair decisions should be individualised, considering bladder capacity and postoperative goals. Three-dimensional ultrasonography provides a novel approach to objectively assess the levator hiatus and explore ultrasonographic predictors of prolapse recurrence, contributing to improved clinical outcomes in pelvic surgery.