title: Levator avulsion is not associated with symptom bother of female pelvic organ prolapse.
abstract: OBJECTIVE
  Both congenital and traumatic factors are likely to play a role in the etiology of female pelvic organ prolapse. We hypothesized that congenital prolapse may be less bothersome than traumatic prolapse related to vaginal childbirth.
  
  
  METHODS
  This is a retrospective study using 482 archived data sets of patients seen for urodynamic testing. Patients had an interview, clinical and sonographic examination using 4D translabial ultrasound. Prolapse bother was determined by visual analog scale (VAS).
  
  
  RESULTS
  A total of 463 patients were seen, of which 254 (55 %) suffered from symptoms of prolapse. The median bother attributable to these symptoms on VAS was 2 (0-10). Clinically significant prolapse was found in 81 % (cystocele 63 %, uterine prolapse 13 %, enterocele 5 %, rectocele 52 %). Evidence of major childbirth-related trauma, i.e., avulsion, was diagnosed in 118 (26 %), and it was bilateral in 9 %. On univariate analysis, clinical stage, maximal prolapse on ultrasound, levator avulsion, vaginal parity and hiatal area were significantly associated with prolapse bother. In a multivariate linear regression analysis, only prolapse extent remained a significant predictor (P < 0.0001), implying that evidence of traumatic prolapse etiology had no significant influence on prolapse bother.
  
  
  CONCLUSIONS
  The presence of levator avulsion did not influence the degree of bother resulting from pelvic organ prolapse symptoms. Hence, increased prolapse bother does not seem to be associated with evidence of traumatic prolapse etiology.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital of the Barmherzige Brueder, Frauenklinik St. Hedwig, University of Regensburg, Steinmetzstraße 1-3, 93049, Regensburg, Germany, Eva.Endress@barmherzige-regensburg.de.
authors.forename: Eva
authors.initials: E
authors.lastname: Endress
authors.forename: K L
authors.initials: KL
authors.lastname: Shek
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000328:Adult; D052858:Cystocele / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010298:Parity; D036801:Parturition; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries*; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging / Q000209:etiology*; D010388:Pelvis; D011247:Pregnancy; D020047:Rectocele / Q000150:complications; D012189:Retrospective Studies; D014463:Ultrasonography; D014596:Uterine Prolapse / Q000000981:diagnostic imaging / Q000209:etiology*; D014623:Vaginal Diseases / Q000150:complications; D064232:Visual Analog Scale