At intake, TPUS was performed in supine position after bladder emptying. Women were instructed to perform maximal pelvic floor contraction and maximal Valsalva maneuver according to the method described by Dietz [13 (link)]. We used a Philips Epiq 7G machine with a X6–1 transducer covered with a gel pad 2 cm thick, and a glove. The gel pad was used to create more distance between the transducer and the woman, so that the LAM could be fully visible within the opening angle on the coronal plane. TPUS volumes analyzed in the current study were acquired without pessary in situ.
An in-house tool was developed in MeVisLab 3.0.2. [14 (link)] for TPUS volume assessment, which was done by one observer (CM) blinded to all clinical data. As described in the literature [15 (link)], hiatal area at rest (HArest), maximal pelvic floor contraction (HActx), and maximal Valsalva maneuver (HAval) were manually segmented at the plane of minimal hiatal dimensions. In addition, the presence of LAM avulsion was assessed on volumes obtained at maximum contraction. Complete avulsion was defined as a levator–urethra gap of ≥25 mm on the three central slices and could be unilateral or bilateral [15 (link)].
An in-house tool was developed in MeVisLab 3.0.2. [14 (link)] for TPUS volume assessment, which was done by one observer (CM) blinded to all clinical data. As described in the literature [15 (link)], hiatal area at rest (HArest), maximal pelvic floor contraction (HActx), and maximal Valsalva maneuver (HAval) were manually segmented at the plane of minimal hiatal dimensions. In addition, the presence of LAM avulsion was assessed on volumes obtained at maximum contraction. Complete avulsion was defined as a levator–urethra gap of ≥25 mm on the three central slices and could be unilateral or bilateral [15 (link)].