Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study. (11th March 2015)

• Record Type: Journal Article
• Authors: Vergeldt, TFM; Notten, KJB; Weemhoff, M; van Kuijk, SMJ; Mulder, FEM; Beets‐Tan, RG; Vliegen, RFA; Gondrie, ETCM; Bergmans, MGM; Roovers, JPWR; Kluivers, KB
• Is Part Of: BJOG. Volume 122:Number 8(2015:Aug.)
• Page Start: 1130
• Page End: 1137
• Publication Date: 2015-03-11
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.13340
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo13340-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo13340-sec-0001" sec-type="section"> <title>Objective</title> <p>To investigate whether increased levator hiatal area, measured preoperatively, was independently associated with anatom‐ical cystocele recurrence 12 months after anterior colporrhaphy.</p> </sec> <sec id="bjo13340-sec-0002" sec-type="section"> <title>Design</title> <p>Multicentre prospective cohort study.</p> </sec> <sec id="bjo13340-sec-0003" sec-type="section"> <title>Setting</title> <p>Nine teaching hospitals in the Netherlands.</p> </sec> <sec id="bjo13340-sec-0004" sec-type="section"> <title>Population</title> <p>Women planned for conventional anterior colporrhaphy without mesh.</p> </sec> <sec id="bjo13340-sec-0005" sec-type="section"> <title>Methods</title> <p>Women underwent physical examination, translabial three‐dimensional (3D) ultrasound and magnetic resonance imaging (MRI) prior to surgery. At 12 months after surgery the physical examination was repeated.</p> </sec> <sec id="bjo13340-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Women with and without anatomical cystocele recurrence were compared to assess the association with levator hiatal area on 3D ultrasound, levator hiatal area on MRI, and potential confounding factors. The receiver operating characteristic (ROC) curve was created to quantify the discriminative ability of using levator hiatal area to predict anatomical cystocele recurrence.</p> </sec> <sec id="bjo13340-sec-0007" sec-type="section"> <title>Results</title> <p>Of 139 included women, 76 (54.7%) had anatomical cystocele recurrence. Preoperative stage 3 or 4 and increased levator hiatal area during Valsalva on ultrasound were significantly associated with cystocele recurrence, with odds ratios of 3.47 (95% confidence interval, 95% CI 1.66–7.28) and 1.06 (95% CI 1.01–1.11) respectively. The area under the ROC curve was 0.60 (95% CI 0.51–0.70) for levator hiatal area during Valsalva on ultrasound, and 0.65 (95% CI 0.55–0.71) for preoperative Pelvic Organ Prolapse Quantification (POP–Q) stage.</p> </sec> <sec id="bjo13340-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Increased levator hiatal area during Valsalva on ultrasound prior to surgery and preoperative stage 3 or 4 are independent risk factors for anatomical cystocele recurrence after anterior colporrhaphy; however, increased levator hiatal area as the sole factor for predicting anatomical cystocele recurrence after surgery shows poor test characteristics.</p> </sec> </abstract>