This study, part of a larger investigation into the outcome of surgery for female pelvic organ prolapse, was performed to determine the prevalence of pubococcygeus muscle detachment from the pubic bone on magnetic resonance imaging (MRI) in women with symptomatic anterior vaginal compartment prolapse.
Axial T2 weighted pelvic MRI was performed on 70 women with symptomatic anterior vaginal compartment prolapse and 18 continent nulliparous normal references. The images were analyzed by 2 observers using a structured grid system to record the attachment of the pubococcygeus muscle (PCM) to the pubic bone, and continuity of the muscle from its origin.
Pubococcygeus muscle detachment from the pubic bone was seen in 39 (56%) of the women with anterior vaginal compartment pelvic organ prolapse. PCM detachment appears more common on the right compared with the left side (49% versus 32% respectively). All the asymptomatic continent nulliparous women had intact muscles.
Pubococcygeal muscle detachment from the pubic bone on MRI is common, and occurs more often on the right side in women with symptomatic anterior vaginal compartment pelvic organ prolapse. The high prevalence of pubococcygeal muscle detachment in women with anterior vaginal compartment prolapse shown in this study may provide an explanation for the high recurrence of anterior vaginal compartment prolapse following anterior vaginal repair.