title: Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study.
abstract: OBJECTIVE
  This study aimed to determine the relationship of recurrent cystocele with avulsion of puborectalis muscle and other risk factors.
  
  
  METHODS
  In this prospective observational cohort study, 245 women undergoing anterior colporrhaphy were invited for a 2-year follow-up visit consisting of a questionnaire, physical examination, and translabial 3D ultrasonography. Women with and without recurrent cystocele were compared to identify recurrence risk factors.
  
  
  RESULTS
  Of the 245 women, 156 agreed to the follow-up visit (63.7%). Objective recurrence rate was 80 of 156 (51.3%). Seventeen of the 156 (10.9%) reported subjective recurrence. Risk factors for anatomical recurrence were complete avulsion of puborectalis muscle (OR, 2.4; 95% CI, 1.3, 4.7), advanced preoperative stage (OR, 2.0; 95% CI, 1.0, 4.1), family history of prolapse (OR, 2.4; 95% CI, 1.2, 4.9), and sacrospinous fixation (OR, 6.5; 95% CI, 2.0, 21.2).
  
  
  CONCLUSIONS
  Risk factors for anatomical cystocele recurrence after anterior colporrhaphy were complete avulsion of puborectalis muscle, advanced preoperative stage, family history of prolapse, and sacrospinous fixation.
authors.affiliation: Department of Obstetrics & Gynecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. m.weemhoff@mumc.nl
authors.forename: Mirjam
authors.initials: M
authors.lastname: Weemhoff
authors.forename: Tineke F M
authors.initials: TF
authors.lastname: Vergeldt
authors.forename: Kim
authors.initials: K
authors.lastname: Notten
authors.forename: Jan
authors.initials: J
authors.lastname: Serroyen
authors.forename: Paul H N M
authors.initials: PH
authors.lastname: Kampschoer
authors.forename: Frans J M E
authors.initials: FJ
authors.lastname: Roumen
mesh_terms: D000368:Aged; D052858:Cystocele / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012445:Sacrococcygeal Region / Q000601:surgery; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014621:Vagina / Q000601:surgery*