title: Temporal latency between pelvic floor trauma and presentation for prolapse surgery: a retrospective observational study.
abstract: OBJECTIVE
  Levator avulsion is an etiological factor for female pelvic organ prolapse (POP) and generally occurs during a first vaginal birth. However, most women with POP present decades later. This study aimed to estimate latency between pelvic floor trauma and presentation for POP surgery.
  
  
  METHODS
  This was a retrospective observational study in a tertiary urogynecological unit to which 354 patients presented for evaluation prior to prolapse surgery between June 2011 and December 2012. All underwent an interview, clinical assessment [International Continence Society Pelvic Organ Prolapse Quantification score (ICS POPQ) and 4D translabial ultrasound (US). Postprocessing analysis of US volumes was blinded against clinical data. The main outcome measure was temporal latency between first vaginal birth and prolapse presentation in women with levator avulsion.
  
  
  RESULTS
  Three hundred and fifty-four patients presented with symptoms of prolapse, of whom 115 (32 %) were found to have an avulsion of the levator ani muscle. Of these, 30 patients were excluded due to previous prolapse surgery, leaving 85, all of whom showed significant prolapse on US and/or clinical staging. Mean latency between first vaginal delivery and presentation was 33.5 (3-66.3) years. There were no associations between latency and potential predictors, except for maternal age at first birth, which was associated with shorter latency (r = -0.45 , P < 0.001). There was a trend toward shorter latency after forceps delivery (P = 0.09).
  
  
  CONCLUSIONS
  Average latency between first birth and presentation for prolapse surgery in women with avulsion was 33.5 (3-66) years. Maternal age at first vaginal birth and possibly forceps delivery were associated with shorter time to presentation.
authors.affiliation: Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Penrith, NSW, 2750, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Thomas
authors.forename: K L
authors.initials: KL
authors.lastname: Shek
authors.forename: R
authors.initials: R
authors.lastname: Guzmán Rojas
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005260:Female; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D010298:Parity; D036801:Parturition; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries*; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D014463:Ultrasonography; D055815:Young Adult
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