Effect of pelvic floor status on the outcome of pelvic organ prolapse surgery

Download PDF Czech version

Authors: J. Dvořák ; Jaromír Mašata ; T. Fučík; A. Martan ; Kamil Švabík
Authors‘ workplace: Klinika gynekologie, porodnictví a neonatologie 1. LF UK a VFN v Praze
Published in: Ceska Gynekol 2023; 88(6): 463-466
Category:

Overview

Pelvic organ prolapse (POP) is a common diagnosis with an incidence in the population of up to 50%. POP causes restrictions in everyday life and reduces patients’ quality of life. Therapy is either conservative in the form of physiotherapy or the use of different types of pessaries, possibly. in case of inappropriateness or failure of conservative treatment, an operative solution is chosen. Avulsion injury of the levator ani muscle (MLA) is a strong factor in the development of POP. Some patients undergo repeated surgeries for POP, negatively impacting their quality of life. Studies show that the stage of POP and avulsion injury is associated with an increased risk of recurrence after index prolapse surgery. Ultrasound diagnosis of MLA injuries might help in predicting the risk of recurrence. Assessment of pelvic floor function is crucial for the success of surgical management of POP.

Keywords:

pelvic floor – pelvic organ prolapse – Reoperation – levator ani muscle – gynaecologic surgery

Sources

1. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 2013; 24 (11): 1783–1790. doi: 10.1007/s00192-013-2169-9.

2. Handa VL, Roem J, Blomquist JL et al. Pelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength. Am J Obstet Gynecol 2019; 221 (1): 41.e1–41.e7. doi: 10.1016/j.ajog.2019.03.004.

3. Wu JM, Matthews CA, Conover MM et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014; 123 (6): 1201–1206. doi: 10.1097/AOG.000 0000000000286.

4. Løwenstein E, Møller LA, Laigaard J et al. Reoperation for pelvic organ prolapse: a Danish cohort study with 15–20 years’ follow--up. Int Urogynecol 2018; 29 (1): 119–124. doi: 10.1007/s00192-017-3395-3.

5. Fučík T, Mašata J. Pelvic neuropathic pain (differential diagnosis). Ceska Gynekol 2021; 86 (4): 279–283. doi: 10.48095/cccg2021279.

6. Friedman T, Eslick GD, Dietz HP. Risk factors for prolapse recurrence: systematic review and meta-analysis. Int Urogynecol J 2018; 29 (1): 13–21. doi: 10.1007/s00192-017-3475-4.

7. Vergeldt TF, Weemhoff M, IntHout J et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J 2015; 26 (11): 1559–1573. doi: 10.1007/s00192-015-2695-8.

8. Diez-Itza I, Aizpitarte I, Becerro A. 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 2007; 18 (11): 1317–1324. doi: 10.1007/s00192-007-0321-0.

9. Weemhoff M, Vergeldt TF, Notten K et al. Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 2012; 23 (1): 65–71. doi: 10.1007/s00192-011-1524-y.

10. Vergeldt TF, Notten KJ, Weemhoff M et al. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study. BJOG 2015; 122 (8): 1130–1137. doi: 10.1111/ 1471-0528.13340.

11. Diez-Itza I, Avila M, Uranga S et al. Factors involved in prolapse recurrence one year after anterior vaginal repair. Int Urogynecol J 2020; 31 (10): 2027–2034. doi: 10.1007/s00192-020-04468-1.

12. Deprest JA, Cartwright R, Dietz HP et al. International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP). Int Urogynecol J 2022; 33 (7): 1699–1710. doi: 10.1007/s00192-022-05081-0.

13. Gillor M, Saens P, Dietz HP. Demographic risk factors for pelvic organ prolapse: do smoking, asthma, heavy lifting or family history matter? Eur J Obstet Gynecol Reprod Biol 2021; 261: 25–28. doi: 10.1016/j.ejogrb.2021.04.006.

14. Allen-Brady K, Cannon-Albright LA, Farnham JM et al. Evidence for pelvic organ prolapse predisposition genes on chromosomes 10 and 17. Am J Obstet Gynecol 2015; 212 (6): 771. e1–771.e7. doi: 10.1016/j.ajog.2014.12.037.

15. Atan IK, Shek KL, Furtado GI et al. The association between levator-urethra gap mea surements and symptoms and signs of female pelvic organ prolapse. Female Pelvic Med Reconstr Surg 2016; 22 (6): 442–446. doi: 10.1097/ SPV.0000000000000311.

16. Dietz HP, Franco AV, Shek KL et al. Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study. Acta Obstet Gynecol Scand 2012; 91 (2): 211–214. doi: 10.1111/j.1600-04 12.2011.01315.x.

17. Paymová L, Švabík K, Kališ V et al. Timing of caesarean section and its impact on levator ani musle avulsion at the first subsequent vaginal birth – a pilot study. Ceska Gynekol 2022; 87 (3): 173–178. doi: 10.48095/cccg2022173.

18. Ismail S, Duckett J, Rizk D et al. Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion. Int Urogynecol J 2016; 27 (11): 1619–1632. doi: 10.1007/s00192-016- 3076-7.

19. Costa J, Towobola B, McDowel C et al. Recurrent pelvic organ prolapse (POP) following traditional vaginal hysterectomy with or without colporrhaphy in an Irish population. Ulster Med J 2014; 83 (1): 16–21.

20. Rodrigo N, Wong V, Shek KL et al. The use of 3-dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery. Aust N Z J Obstet Gynaecol 2014; 54 (3): 206–211. doi: 10.1111/ajo.12171.

21. Model AN, Shek KL, Dietz HP. Levator defects are associated with prolapse after pelvic floor surgery. Eur J Obstet Gynecol Reprod Biol 2010; 153 (2): 220–223. doi: 10.1016/ j.ejogrb.2010.07.046.

22. Nyhus MØ, Mathew S, Salvesen KÅ et al. The impact of levator ani muscle trauma and contraction on recurrence after prolapse surgery. Int Urogynecol J 2022; 33 (10): 2879–2885. doi: 10.1007/s00192-022-05168-8.

23. Dietz HP, Chantarasorn V, Shek KL. Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 2010; 36 (1): 76–80. doi: 10.1002/uog.7678.

24. Wyman AM, Greene KA, Bassaly R et al. Levator ani muscle defects in patients with surgical failure. Female Pelvic Med Reconstr Surg 2017; 23 (2): 114–117. doi: 10.1097/SPV.0000 000000000380.

25. Blandon RE, Bharucha AE, Melton LJ 3rd et al. Incidence of pelvic floor repair after hysterectomy: a population-based cohort study. Am J Obstet Gynecol 2007; 197 (6): 664.e1–664.e7. doi: 10.1016/j.ajog.2007.08.064.

26. Oversand SH, Staff AC, Volløyhaug I et al. Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery. Acta Obstet Gynecol Scand 2019; 98 (8): 1046–1054. doi: 10.1111/aogs.13604.

27. Rosen DM, Shukla A, Cario GM et al. Is Hysterectomy necessary for laparoscopic pelvic floor repair? A prospective study. J Minim Invasive Gynecol 2008; 15 (6): 729–734. doi: 10.1016/ j.jmig.2008.08.010.

28. Santis-Moya F, Pineda R, Miranda V. Preoperative ultrasound findings as risk factors of recurrence of pelvic organ prolapse after laparoscopic sacrocolpopexy. Int Urogynecol J 2021; 32 (4): 955–960. doi: 10.1007/s00192-020-04503-1.

29. Pan K, Cao L, Ryan NA et al. Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J 2016; 27 (1): 93–101. doi: 10.1007/s00192-015-2755-9.

30. Diwadkar GB, Barber MD, Feiner B et al. Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 2009; 113 (2 Pt 1): 367–373. doi: 10.1097/AOG.0b013e318195888d.

31. Wong NK, Cheung RY, Lee LL et al. Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery. Ultrasound Obstet Gynecol 2021; 57 (4): 631–638. doi: 10.1002/uog.23109.

32. Svabik K, Martan A, Masata J et al. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol 2014; 43 (4): 365–371. doi: 10.1002/uog.13305.

33. Giugale LE, Hansbarger MM, Askew AL et al. Assessing pelvic organ prolapse recurrence after minimally invasive sacrocolpopexy: does mesh weight matter? Int Urogynecol J 2021; 32 (8): 2195–2201. doi: 10.1007/s00192-021-046 81-6.