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International Urogynecology Journal

Published in:

01-06-2013 | Original Article

Can levator avulsion be repaired surgically? A prospective surgical pilot study

Authors: H. P. Dietz, K. L. Shek, O. Daly, A. Korda

Published in: International Urogynecology Journal | Issue 6/2013

Abstract

Introduction and hypothesis

Avulsion of the puborectalis muscle from its bony insertion is common in women presenting with prolapse. We present a simple vaginal technique for levator reconstruction.

Methods

This is a prospective surgical pilot study comprising 17 patients enrolled to undergo levator repair in the context of prolapse surgery. This was performed through a lateral colpotomy at the level of the hymen using a mesh patch for reinforcement.

Results

We performed 20 levator repairs in 17 women (three bilateral). There were no intraoperative complications. Recovery was unremarkable in all cases. Results are given for a mean follow-up of 1.3 years. Most (13/17, 76 %) women were satisfied with the outcome. Six patients complained of symptoms of recurrent prolapse, three of de novo dyspareunia, and four of pain related to the repair site on palpation. There were two mesh erosions, one of which healed with oestrogen treatment. Prolapse recurrence beyond the hymen was observed in five patients. The mean hiatal area on Valsalva was reduced from 36.84 cm² to 30.71 cm² (P = 0.001).

Conclusions

Direct surgical repair of a levator avulsion is feasible at the time of prolapse surgery. However, its effect on prolapse recurrence and hiatal dimensions is relatively disappointing, suggesting that there often is microscopic trauma and functional muscle impairment in addition to the avulsion.

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Title: Can levator avulsion be repaired surgically? A prospective surgical pilot study
Authors: H. P. Dietz
K. L. Shek
O. Daly
A. Korda
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 6/2013
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1984-8

At a glance: The STEP trials

Springer Medicine

Can levator avulsion be repaired surgically? A prospective surgical pilot study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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