Temporal latency between pelvic floor trauma and presentation for prolapse surgery: a retrospective observational study
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Introduction and hypothesis
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.
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.
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).
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.
KeywordsBirth trauma Levator ani Pelvic organ prolapse Ultrasound
Conflict of interest
H.P. Dietz received unrestricted educational grants from GE Medical. K.L. Shek received an unrestricted educational grant from GE Medical. Vanessa Thomas and R. Guzmán Rojas have no conflict of interest to declare.
Details of ethics approval
The study was approved by the Human Research Ethics Committee of Nepean Blue Mountains Health District (NBMLHD 12-71)
Contribution to authorship
VT: Conception and design; data acquisition, analysis, and interpretation; drafting the article; and final approval of the version to be published
KS: Data nalysis and Interpretation; drafting the article; and final approval of the version to be published.
RGR: Access of reliability series; data analysis and Interpretation; drafting the article; and final approval of the version to be published.
HPD: Conception and design; data analysis and interpretation; drafting and critically revising the article for important intellectual content; and final approval of the version to be published.
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