title: Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement?
abstract: OBJECTIVE
  Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh.
  
  
  METHODS
  This was a retrospective analysis of data obtained from three surgical audits for subjective and objective outcomes following anterior colporrhaphy with mesh. Recurrence was defined as cystocele ≥ Stage 2 on the prolapse quantification system of the International Continence Society; symptoms of vaginal lump/bulge; or cystocele on ultrasound, defined as maximum bladder descent to ≥ 10 mm below the symphysis pubis. Levator avulsion was diagnosed using tomographic ultrasound imaging.
  
  
  RESULTS
  Two hundred and nine patients were followed up at a mean of 2.2 years (range, 3 months to 5.6 years) after anterior vaginal mesh placement. 24% (51/209) had recurrent prolapse symptoms, 33% (68/209) clinical cystocele recurrence ≥ Stage 2, and 26% (54/209) a recurrent cystocele on ultrasound. Twenty-eight out of 80 (35%) women with levator avulsion had significant sonographic cystocele recurrence (odds ratio (OR), 2.24 (95% confidence interval (CI), 1.13-4.43)). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression (OR, 2.13 (95% CI, 1.04-4.39); P = 0.04).
  
  
  CONCLUSIONS
  Levator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh.
authors: Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia. vivwlp@yahoo.co.nz
authors: V
authors: V
authors: Wong
authors: K
authors: K
authors: Shek
authors: A
authors: A
authors: Rane
authors: J
authors: J
authors: Goh
authors: H
authors: H
authors: Krause
authors: H P
authors: HP
authors: Dietz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000502:physiology; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging; D012307:Risk Factors; D055502:Secondary Prevention; D013526:Surgical Mesh; D016896:Treatment Outcome; D014463:Ultrasonography; D014621:Vagina / Q000601:surgery*
keywords: anterior colporrhaphy; cystocele; levator avulsion; mesh; pelvic organ prolapse; recurrence