OP28.02: Levator ani muscle avulsion and risk of recurrence after facial surgery for pelvic organ prolapse: preliminary results

Abstract

To evaluate the relationship between the levator ani muscle (LAM) avulsion and long-term risk of pelvic organ prolapse (POP) recurrence after pelvic floor fascial surgery. Consecutive patients who underwent pelvic floor fascial surgery for POP (uterine prolapse and/or cystocele) during January 2011 and December 2015 were prospectively recruited during follow-up period in this ongoing study. Patient's assessment included a standardised interview, clinical examination and four-dimensional translabial ultrasound. All patients underwent a strict sonographic protocol performed with the women supine after voiding, using a GE Voluson E8 and S10 units, during maximal Valsalva manoeuvre and Pelvic Floor muscle contraction. LAM avulsion was assessed using volume contrast imaging (VCI) analysis (by two millimetres slices) and tomographic ultrasound imaging (TUI) at 2.5-mm slice intervals on volumes obtained on Pelvic Floor muscle contraction. 80 patients were enrolled. Mean age was 67 years (range 52-85). Mean parity was 2.6 (range 1-6). Mean BMI was 24.6 (range 19.5-33.2). Mean follow-up 25.5 months (15-42). LAM avulsion was observed in 14 patients (17.5%). POP recurrence after pelvic floor fascial surgery was observed in 5 patients (6%). In three out of these five cases (60%), LAM avulsion was diagnosed. Patients with LAM avulsion (#14) showed a significantly higher rate of POP recurrence after pelvic floor fascial surgery compared to patients without avulsion (#66) (21% vs 3%, respectively). Pelvic floor fascial surgery showed to be effective with a low risk of recurrence. LAM avulsion revealed to be related with a higher risk of POP recurrence after pelvic floor fascial surgery. A proper assessment of LAM trauma seems to be of paramount relevance to strictly select patients requiring a fascial or a mesh surgery.