Levator avulsion is a risk factor for cystocele recurrence

Dietz, Hans Peter; Chantarasorn, Varisara; Shek, Ka Lai

doi:10.1002/uog.7678

Cited by 159 publications

(123 citation statements)

References 35 publications

(38 reference statements)

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“…70 More recently, levator avulsion defects have also been found to be strongly associated with recurrent pelvic organ prolapse after prolapse repair. [73][74][75] It is likely that the conflicting results in the published literature on the association between collagen and prolapse aetiology are complicated by the presence of major anatomical trauma related to childbirth, as these factors are often not taken into account and controlled for during the assessment of collagen integrity. Potential ways to reduce this confounding bias include limiting the study population to nulliparous women only and incorporating diagnosis and assessment for levator avulsion.…”

Section: Discussionmentioning

confidence: 99%

Recent studies of genetic dysfunction in pelvic organ prolapse: The role of collagen defects

Lim

Khoo

Wong

et al. 2014

Aust NZ J Obst Gynaeco

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Gynaecologists are becoming increasingly aware that women with a family history of prolapse are at an increased risk of prolapse refractory to treatment. In the past five years, several genetic mutations have been shown to correlate with increased prolapse susceptibility. These mutations can result in disordered collagen metabolism, which weaken the fascial support of the pelvic organs. This review examines the contemporary evidence regarding the role of collagen in prolapse.

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Section: Discussionmentioning

confidence: 99%

Recent studies of genetic dysfunction in pelvic organ prolapse: The role of collagen defects

Lim

Khoo

Wong

et al. 2014

Aust NZ J Obst Gynaeco

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“…More recently levator avulsion 3 , 12 , 46 , 49 , 50 and hiatal ballooning, 43 i.e. excessive distensibility of the levator hiatus, have been shown to be important risk factors for prolapse recurrence.…”

Section: Methodsmentioning

confidence: 99%

“…Levator avulsion, a form of maternal birth injury where the most ventromedial aspect of the levator ani muscle is detached from the inferior ramus of the os pubis, has been reported in 10–35% of women after a first vaginal birth 51 53 It is associated with hiatal ballooning, reduced pelvic floor muscle contractility and increased muscle distensibility 54 and has been shown to be a predictor for anterior compartment recurrence with an odds ratio of around 2.5 to 3.0 3 , 46 after anterior colporrhaphy. The impact of major levator defects has been confirmed on MRI.…”

Section: Methodsmentioning

confidence: 99%

Imaging of slings and meshes

Shek

Dietz

2014

Australas J Ultrason Med

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The popularity of imaging in pelvic floor medicine continues to increase. Among the various modalities, ultrasound is superior as it is cheap, safe, easily accesible and simple, resulting in high patient compliance. It is the only technique that allows imaging of modern wide‐weave polypropylene sling or mesh implants, and imaging of such implants is commonly required due to the popularity of surgical techniques that involve the placement of slings and meshes. This review article will discuss the role of translabial ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse.

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“…The risk of recurrence appears to increase almost twofold in patients with levator defects (avulsion of the pubococcygeus muscle from the pubic rami) [67][68][69][70].…”

Section: Recommendations For Conservative Therapymentioning

confidence: 99%

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Baeßler

Aigmüller

Albrich

et al. 2016

Geburtshilfe Frauenheilkd

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Ziel: Erstellung einer offiziellen, internationalen, interdisziplinären Leitlinie, publiziert und koordiniert von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Die Leitlinie wurde für den deutschsprachigen Raum entwickelt und wird neben der DGGG auch von der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) und der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) mitgetragen. Das Ziel dieser Leitlinie, die von der DGGG publiziert und koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen evidenzbasierten Überblick über die Diagnostik sowie konservative und operative Therapie des Descensus genitalis der Frau mit oder ohne Belastungsinkontinenz zu geben. Methoden: Es erfolgte ein systematischer Review sowie Synthese von Daten, anteilig mit Metaanalyse (S2e). Es wurde eine umfassende Literatursuche in MEDLINE, Embase, Cinahl, Pedro und im Cochrane-Register, in Referenzlisten und in den Abstracts der Annual Meetings der International Continence Society und der International Urogynecological Association durchgeführt. Abstracts wurden eingeschlossen, wenn es sich um randomisierte Studien handelte, die als Podiumpräsentation vorgestellt und diskutiert wurden. Es wurden Originalarbeiten seit 2008 eingeschlossen, deren Nachkontrollzeitraum bei mindestens 12 Monaten lag. Für die Beschreibung von perioperativen Komplikationen wurden jegliche Daten herangezogen. Empfehlungen: Es werden Empfehlungen zur Diagnostik, konservativen und operativen Therapie des Genitaldeszensus gegeben, wobei die 3 urogynäkologischen Kompartimente, Prävention oder Behandlung von Belastungsinkontinenz, Vor-und Nachteile von Netzaugmentationen sowie uteruserhaltende Optionen, berücksichtigt

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Levator avulsion is a risk factor for cystocele recurrence

Abstract: Objectives To determine whether levator avulsion is a risk factor for recurrence after cystocele repair. Methods

Cited by 159 publications

References 35 publications

Recent studies of genetic dysfunction in pelvic organ prolapse: The role of collagen defects

Recent studies of genetic dysfunction in pelvic organ prolapse: The role of collagen defects

Imaging of slings and meshes

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

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