title: Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study.
abstract: OBJECTIVE
  To investigate whether increased levator hiatal area, measured preoperatively, was independently associated with anatom-ical cystocele recurrence 12 months after anterior colporrhaphy.
  
  
  METHODS
  Multicentre prospective cohort study.
  
  
  METHODS
  Nine teaching hospitals in the Netherlands.
  
  
  METHODS
  Women planned for conventional anterior colporrhaphy without mesh.
  
  
  METHODS
  Women underwent physical examination, translabial three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) prior to surgery. At 12 months after surgery the physical examination was repeated.
  
  
  METHODS
  Women with and without anatomical cystocele recurrence were compared to assess the association with levator hiatal area on 3D ultrasound, levator hiatal area on MRI, and potential confounding factors. The receiver operating characteristic (ROC) curve was created to quantify the discriminative ability of using levator hiatal area to predict anatomical cystocele recurrence.
  
  
  RESULTS
  Of 139 included women, 76 (54.7%) had anatomical cystocele recurrence. Preoperative stage 3 or 4 and increased levator hiatal area during Valsalva on ultrasound were significantly associated with cystocele recurrence, with odds ratios of 3.47 (95% confidence interval, 95% CI 1.66-7.28) and 1.06 (95% CI 1.01-1.11) respectively. The area under the ROC curve was 0.60 (95% CI 0.51-0.70) for levator hiatal area during Valsalva on ultrasound, and 0.65 (95% CI 0.55-0.71) for preoperative Pelvic Organ Prolapse Quantification (POP-Q) stage.
  
  
  CONCLUSIONS
  Increased levator hiatal area during Valsalva on ultrasound prior to surgery and preoperative stage 3 or 4 are independent risk factors for anatomical cystocele recurrence after anterior colporrhaphy; however, increased levator hiatal area as the sole factor for predicting anatomical cystocele recurrence after surgery shows poor test characteristics.
authors.affiliation: Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: T F M
authors.initials: TF
authors.lastname: Vergeldt
authors.affiliation: Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: K J B
authors.initials: KJ
authors.lastname: Notten
authors.affiliation: Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Heerlen, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Weemhoff
authors.affiliation: Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: S M J
authors.initials: SM
authors.lastname: van Kuijk
authors.affiliation: Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: F E M
authors.initials: FE
authors.lastname: Mulder
authors.affiliation: Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: R G
authors.initials: RG
authors.lastname: Beets-Tan
authors.affiliation: Radiology, Atrium Medical Centre Parkstad, Heerlen, the Netherlands.
authors.forename: R F A
authors.initials: RF
authors.lastname: Vliegen
authors.affiliation: Obstetrics and Gynaecology, Orbis Medical Centre, Sittard, the Netherlands.
authors.forename: E T C M
authors.initials: ET
authors.lastname: Gondrie
authors.affiliation: Obstetrics and Gynaecology, Laurentius Medical Centre, Roermond, the Netherlands.
authors.forename: M G M
authors.initials: MG
authors.lastname: Bergmans
authors.affiliation: Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: J P W R
authors.initials: JP
authors.lastname: Roovers
authors.affiliation: Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: K B
authors.initials: KB
authors.lastname: Kluivers
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D052858:Cystocele / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009426:Netherlands; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000502:physiology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014463:Ultrasonography; D014636:Valsalva Maneuver / Q000502:physiology
keywords: Cystocele recurrence; levator hiatal area; translabial 3D ultrasound