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Levator Ani Muscle Defects in Patients With Surgical Failure

Wyman, Allison M. MD; Greene, Kristie A. MD; Bassaly, Renee DO; Hahn, Lindsey DO; Patton, Simon MD; Miladinovic, Branko PhD; Hoyte, Lennox MD, MSEE/CS

Female Pelvic Medicine & Reconstructive Surgery: March/April 2017 - Volume 23 - Issue 2 - p 114–117
doi: 10.1097/SPV.0000000000000380
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Introduction The objective of the study was to use a well-described system of measuring levator ani (LA) muscle defects from magnetic resonance images to evaluate whether major defects are correlated to an increased risk of surgical failure.

Methods A retrospective cohort study performed on patients who underwent laparoscopic uterosacral ligament suspension from 2010 to 2012. Surgical failure was defined as a composite score of anatomic bulge beyond the hymen with sensation of bulge or repeat treatment of prolapse via pessary or surgery by 1-year follow-up. Levator ani muscle defects were graded by a score of 0 (no defect), 1 (<50% muscle bulk missing), 2 (>50% muscle bulk missing), or 3 (complete loss of muscle). Total score is the sum from both graded sides, with 0 classified as having no defect, 1 to 3 classified as having minor defects, and 4 to 6 classified as having major defects. Dichotomous values of LA major defects were compared against dichotomous values of surgical outcomes via a contingency table. Fisher exact test was then performed to correlate major defects to surgical success/failure. P value of less than 0.05 was considered statistically significant.

Results Sixty-six women met the inclusion criteria. Thirteen (19.6%) patients met the criteria for surgical failure at 1 year. Of the 13, 54% (7) had a major defect, and 46% (6) had a minor or no defect (odds ratio, 1.31; 95% confidence interval, 0.39–4.41; P = 0.762).

Conclusions We did not find a statistical correlation to surgical failure after a laparoscopic uterosacral ligament suspension with LA muscle defects on preoperative magnetic resonance images within this specific patient population.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.

Reprints: Allison M. Wyman, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, STC Bldg, 6th Floor, 2 Tampa General Circle, Tampa, FL 33606. E-mail:

The authors have declared they have no conflicts of interest.

Presented orally as a poster at the upcoming AUGS 37th Annual Scientific Meeting/PFD Week, September 27 to October 1, 2016, Denver, Colorado.

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