Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement?

Wong, V., Shek, K., Rane, A., Goh, J., Krause, H., and Dietz, H.P. (2013) Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement? Ultrasound in Obstetrics and Gynecology, 42 (2). pp. 230-234.

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Abstract

Objective: Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh.

Methods: This was a retrospective analysis of data obtained from three surgical audits for subjective and objective outcomes following anterior colporrhaphy with mesh. Recurrence was defined as cystocele ≥ Stage 2 on the prolapse quantification system of the International Continence Society; symptoms of vaginal lump/bulge; or cystocele on ultrasound, defined as maximum bladder descent to ≥ 10 mm below the symphysis pubis. Levator avulsion was diagnosed using tomographic ultrasound imaging.

Results: Two hundred and nine patients were followed up at a mean of 2.2 years (range, 3  months to 5.6 years) after anterior vaginal mesh placement. 24% (51/209) had recurrent prolapse symptoms, 33% (68/209) clinical cystocele recurrence ≥ Stage 2, and 26% (54/209) a recurrent cystocele on ultrasound. Twenty-eight out of 80 (35%) women with levator avulsion had significant sonographic cystocele recurrence (odds ratio (OR), 2.24 (95% confidence interval (CI), 1.13–4.43)). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression (OR, 2.13 (95% CI, 1.04–4.39); P = 0.04).

Conclusion: Levator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh.

Item ID: 31740
Item Type: Article (Research - C1)
ISSN: 1469-0705
Keywords: anterior colporrhaphy, cystocele, levator avulsion, mesh, pelvic organ prolapse, recurrence
Date Deposited: 26 Feb 2014 09:53
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110323 Surgery @ 60%
11 MEDICAL AND HEALTH SCIENCES > 1114 Paediatrics and Reproductive Medicine > 111402 Obstetrics and Gynaecology @ 40%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 60%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920114 Reproductive System and Disorders @ 40%
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