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Open Access 01-01-2012 | Original Article

Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study

Authors: Mirjam Weemhoff, Tineke F. M. Vergeldt, Kim Notten, Jan Serroyen, Paul H. N. M. Kampschoer, Frans J. M. E. Roumen

Published in: International Urogynecology Journal | Issue 1/2012

Abstract

Introduction and hypothesis

This study aimed to determine the relationship of recurrent cystocele with avulsion of puborectalis muscle and other risk factors.

Methods

In this prospective observational cohort study, 245 women undergoing anterior colporrhaphy were invited for a 2-year follow-up visit consisting of a questionnaire, physical examination, and translabial 3D ultrasonography. Women with and without recurrent cystocele were compared to identify recurrence risk factors.

Results

Of the 245 women, 156 agreed to the follow-up visit (63.7%). Objective recurrence rate was 80 of 156 (51.3%). Seventeen of the 156 (10.9%) reported subjective recurrence. Risk factors for anatomical recurrence were complete avulsion of puborectalis muscle (OR, 2.4; 95% CI, 1.3, 4.7), advanced preoperative stage (OR, 2.0; 95% CI, 1.0, 4.1), family history of prolapse (OR, 2.4; 95% CI, 1.2, 4.9), and sacrospinous fixation (OR, 6.5; 95% CI, 2.0, 21.2).

Conclusions

Risk factors for anatomical cystocele recurrence after anterior colporrhaphy were complete avulsion of puborectalis muscle, advanced preoperative stage, family history of prolapse, and sacrospinous fixation.

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRef

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186:1160–1166PubMedCrossRef

Miedel A, Tegerstedt G, Morlin B, Hammarstrom M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 9:1593–1601

Progetto Menopausa Italia Study Group (2000) Risk factors for genital prolapse in non-hysterectomized women around menopause. Results from a large cross-sectional study in menopausal clinics in Italy. Eur J Obstet Gynecol Reprod Biol 93:135–140CrossRef

Amselem C, Puigdollers A, Azpiroz F, Sala C, Videla S, Fernandez-Fraga X et al (2009) Constipation: a potential cause of pelvic floor damage? Neurogastroenterol Motil 22:150–153PubMedCrossRef

Moalli PA, Jones Ivy S, Meyn LA, Zyczynski HM (2003) Risk factors associated with pelvic floor disorders in women undergoing surgical repair. Obstet Gynecol 101:869–874PubMedCrossRef

Chiaffarino F, Chatenoud L, Dindelli M, Meschia M, Buonaguidi A, Amicarelli F et al (1999) Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol 82:63–67PubMedCrossRef

McLennan MT, Harris JK, Kariuki B, Meyer S (2008) Family history as a risk factor for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19:1063–1069PubMedCrossRef

Kim CM, Jeon MJ, Chung DJ, Kim SK, Kim JW, Bai SW (2007) Risk factors for pelvic organ prolapse. Int J Gynaecol Obstet 98:248–251PubMedCrossRef

10.

Mant J, Painter R, Vessey M (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 104:579–585PubMedCrossRef

11.

Dietz HP (2008) The aetiology of prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19:1323–1329PubMedCrossRef

12.

DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101:46–53PubMedCrossRef

13.

Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. Bjog 115:979–984PubMedCrossRef

14.

DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302PubMedCrossRef

15.

Weemhoff MWM, Korsten L, Serroyen J, Kampschöer PHNM, Roumen FJME (2010) Postoperative catheterization after anterior colporrhaphy: 2 days versus 5 days. A multicentre randomized controlled trial. Int Urogynecol J 22:477–483PubMedCrossRef

16.

Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res 3:291–306PubMedCrossRef

17.

van der Vaart CH, de Leeuw JR, Roovers JP, Heintz AP (2003) Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 22:97–104PubMedCrossRef

18.

van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH (2006) Defecatory symptoms during and after the first pregnancy: prevalences and associated factors. Int Urogynecol J Pelvic Floor Dysfunct 17:224–230PubMedCrossRef

19.

Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRef

20.

Dietz HP (2007) Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 29:329–334PubMedCrossRef

21.

Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. Bjog 113:225–230PubMedCrossRef

22.

Dietz HP, Bernando MJ, Kirby A, Shek KL (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22:699–704PubMedCrossRef

23.

Sand PK, Koduri S, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ et al (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1362PubMedCrossRef

24.

Dietz HP, Chantarasorn V, Shek K (2010) Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 36:76–80PubMedCrossRef

25.

Diez-Itza I, Aizpitarte I, Becerro A (2007) Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct 18:1317–1324PubMedCrossRef

26.

Ghetti C, Gregory WT, Edwards SR, Otto LN, Clark AL (2005) Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol 193:53–57PubMedCrossRef

27.

Jeon MJ, Chung SM, Jung HJ, Kim SK, Bai SW (2008) Risk factors for the recurrence of pelvic organ prolapse. Gynecol Obstet Invest 66:268–273PubMedCrossRef

28.

Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M et al (2009) Identification of risk factors for genital prolapse recurrence. Neurourol Urodyn 28:301–304PubMedCrossRef

29.

Whiteside JL, Weber AM, Meyn LA, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 191:1533–1538PubMedCrossRef

30.

Smilen SW, Saini J, Wallach SJ, Porges RF (1998) The risk of cystocele after sacrospinous ligament fixation. Am J Obstet Gynecol 179:1465–1471PubMedCrossRef

Title: Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study
Authors: Mirjam Weemhoff
Tineke F. M. Vergeldt
Kim Notten
Jan Serroyen
Paul H. N. M. Kampschoer
Frans J. M. E. Roumen
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 1/2012
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-011-1524-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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