Abstract
Introduction
Levator ani muscle (LAM) lesions are an important factor in the development of female
pelvic organ prolapse (POP).
Objective
To determine the prevalence of LAM avulsion by transperineal ultrasound. The second
outcome is to evaluate the association between complete avulsion and the type, degree,
and number of POP compartments involved.
Materials and methods
This was a retrospective cohort study performed in a tertiary hospital that included
patients with pelvic floor dysfunction evaluated from January 2016 to March 2020.
The presence of LAM avulsion was diagnosed by 3D/4D pelvic floor transperineal ultrasound.
We identified women with POP, and they were classified according to the POP-Q system.
The association between complete avulsion and the type, degree and number of compartments
were calculated using generalized logit models.
Results
848 women were included in the analysis. A complete LAM avulsion was found in 195
patients (23 %). Patients with complete avulsion were 4.7 (CI: 1.98–11.5) times more
likely to have POP than patients with partial avulsion. The anterior compartment was
the most frequently affected (n = 605, 25.8 %). Women with severe stage POP were 3.13
times (CI: 1.90–5.16) more likely to have bilateral complete LAM avulsion than women
with mild prolapse. Patients with three-compartment POP were 2.75 times (CI: 1.53–4.94)
more likely to have unilateral complete LAM avulsion than women with POP in one compartment.
Conclusion
The prevalence of LAM avulsion is high in patients with urogynecological symptoms.
Patients with complete LAM avulsion are at greater risk of developing POP and have
a more advanced stage of prolapse and involvement of multiple compartments.
Keywords
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Article info
Publication history
Published online: September 29, 2022
Accepted:
September 26,
2022
Received in revised form:
September 22,
2022
Received:
March 1,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
