Pelvic floor morphology in the standing position using upright computed tomography: age and sex differences

Keiichi Narita, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Takehiro Nakahara, Masahiro Jinzaki

Research output: Contribution to journalArticle

Abstract

Introduction and hypothesis: This study was aimed at comparing pelvic floor parameters between the standing and supine positions using upright computed tomography (CT) and evaluating the effects of sex and age in normal healthy volunteers. Methods: In total, 139 volunteers (70 men, mean 46.7 years; 69 women, mean 47.3 years) underwent both upright CT in the standing position and conventional CT in the supine position. The distances from the bladder neck to the pubococcygeal line (PCL) and anorectal junction (ARJ), defined as the posterior aspect of the puborectalis muscle, to PCL were measured. The length, width, and area of the levator hiatus (LH) were measured on oblique axial images. Results: The bladder neck (men, 22.2 ± 4.9 mm vs 28.3 ± 5.3 mm; women, 9.0 ± 5.1 mm vs 19.0 ± 4.0 mm) and ARJ (men, −18.8 ± 5.5 mm vs −12.1 ± 5.1 mm; women, −20.0 ± 4.7 mm vs −11.2 ± 4.3 mm) were significantly lower in the standing position than in the supine position (all p < 0.0001). The LH area (men, 1,990 ± 380 mm2 vs 1,697 ± 329 mm2; women, 2,284 ± 344 mm2 vs 1,811 ± 261 mm2) was significantly larger in the standing position (both p < 0.0001). Differences in all parameters between the standing and supine positions were larger in women than in men. ARJ in women showed a significant tendency to descend with age only in the standing position (r = −0.29, p = 0.017). Conclusions: The bladder neck and ARJ descend and the LH area enlarges in the standing position. Pelvic floor mobility is greater in women than in men. Descent of the ARJ in the standing position is associated with aging in women.

Original languageEnglish
JournalInternational Urogynecology Journal
DOIs
Publication statusAccepted/In press - 2020 Jan 1

Keywords

  • Aging
  • Computed tomography
  • Pelvic floor
  • Reference values
  • Sex differences
  • Standing position

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Urology

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