The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

Abstract

Aims: Female pelvic organ prolapse is a common condition. Prolapse recurrence following surgical treatment is a significant clinical issue. The aim of this study was to determine risk factors for recurrence, attempting to improve clinical practice by allowing better patient selection prior to surgery. Methods: This was a retrospective study utilising patient records and ultrasound volume imaging data sets obtained in four clinical audits following anterior colporrhaphy AE mesh. Prolapse recurrence was diagnosed clinically and by ultrasound; findings were analysed against potential predictors. Results: Symptomatic prolapse recurrence was demonstrated in 86 (26%), on clinical examination in 141 (42%) and on ultrasound in 113/334 women (34%). None of the tested predictors were predictive of recurrent symptoms, likely due to a lack of power. However, both levator avulsion and hiatal area on Valsalva were shown to be highly significant predictors of objective prolapse recurrence on clinical examination and ultrasound. Conclusions: Prolapse recurrence following surgery is a common complaint. The state of the patient's pelvic floor muscle seems to be the strongest determinant.

MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures

“…It demonstrates excellent visibility of segments of the mesh between the vagina and bladder [6]. It has proven to be especially useful in diagnosing mesh folding or dislodgement [6] or in evaluating recurrent cystoceles after anterior colporrhaphy using alloplastic material [21, 22]. Because of its favorable cost/benefit ratio and the ability to do real-time viewing, we believe ultrasound will remain the main-stay for most clinical situations.…”

Perineal and vaginal tears are clinical markers for occult levator ani trauma: a retrospective observational study

“…While neurological, vascular and fascial damage may also be important in the pathogenesis of POP, one of the pathophysiological mechanisms seems to involve trauma to the levator ani muscle. Levator avulsion, a form of maternal injury in which the puborectalis becomes detached from the os pubis as a result of vaginal delivery, has been shown to be associated with anterior and central compartment prolapse and is a risk factor for prolapse recurrence. Diagnosis in the delivery room is usually impossible, as levator avulsion is commonly occult and difficult to assess even if exposed by vaginal tears.…”

The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

“…The findings of this review suggest that there is no impact—improvement or deterioration—on PFM function as a result of POP/UI surgery. Given this, and the current lack of evidence to support perioperative PFM training, we may need to be guided by findings from studies that have shown a strong association between poorer preoperative PFM status and poorer postoperative PFM function . Therefore, focusing intervention on women with poor PFM function preoperatively, who are most likely to respond may be the best approach to achieve more effective outcomes from perioperative PFM interventions.…”