title: Levator avulsion is a risk factor for cystocele recurrence.
abstract: OBJECTIVE
  To determine whether levator avulsion is a risk factor for recurrence after cystocele repair.
  
  
  METHODS
  This was an audit of women who underwent anterior colporrhaphy at a tertiary hospital between 2002 and 2005, who were followed up by interview, clinical examination and four-dimensional translabial ultrasound examination 3-6 years later.
  
  
  RESULTS
  Of 242 patients identified through theater records we were able to contact 171 (71%). Of 83 who agreed to attend, 24 (29%) reported symptoms of recurrent prolapse. There were 33 (40%) recurrent cystoceles (ICS POP-Q ≥ 0), [corrected] and 34 (41%) had a significant cystocele on ultrasound examination. On pelvic floor tomographic ultrasound examination, a levator avulsion was detected in 29 (35%) patients. The relative risk of recurrence in women with avulsion was 3.9 (95% CI, 2.4-5.8) when ultrasound criteria of recurrent cystocele were used, and 2.9 (95% CI, 1.7-4.5) when using clinical staging.
  
  
  CONCLUSIONS
  Levator avulsion is associated with a relative risk of 3-4 for cystocele recurrence after anterior colporrhaphy.
authors.affiliation: Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Australia. hpdietz@bigpond.com
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
authors.forename: V
authors.initials: V
authors.lastname: Chantarasorn
authors.forename: K L
authors.initials: KL
authors.lastname: Shek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries*; D054869:Clinical Audit; D052858:Cystocele / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography