Levator avulsion is a risk factor for cystocele recurrence

Objectives To determine whether levator avulsion is arisk factor for recurrence after cystocele repair. Methods This was an audit of women who underwentanterior colporrhaphy at a tertiary hospital between 2002and 2005, who were followed up by interview, clinicalexamination and four-dimensional translabial ultrasoundexamination 3-6 years later. Results Of 242 patients identified through theater recordswe were able to contact 171 (71%). Of 83 who agreedto attend, 24 (29%) reported symptoms of recurrentprolapse. There were 33 (40%) recurrent cystoceles(Stage 2+), and 34 (41%) had a significant cystoceleon ultrasound examination. On pelvic floor tomographicultrasound examination, a levator avulsion was detectedin 29 (35%) patients. The relative risk of recurrence inwomen with avulsion was 3.9 (95% CI, 2.4-5.8) whenultrasound criteria of recurrent cystocele were used, and2.9 (95% CI, 1.7-4.5) when using clinical staging. Conclusion Levator avulsion is associated with a relativerisk of 3-4 for cystocele recurrence after anteriorcolporrhaphy.