Levator ani deficiency and pelvic organ prolapse severity.

OBJECTIVE

To estimate whether levator ani deficiency severity is a predictor of clinically significant pelvic organ prolapse (POP) and to determine whether there is a levator ani deficiency threshold above which POP occurs.

METHODS

Two-hundred twenty three-dimensional ultrasound scans performed on urogynecologic clinic patients were reviewed, and each levator ani muscle subdivision was individually scored (0=no defect, 1=50% or less defect, 2=more than 50% defect, 3=total absence of the muscle) on each side. A levator ani deficiency score was calculated and categorized as mild (score 0-6), moderate (score 7-12), and severe (score more than 13). Clinically significant prolapse was defined as stage 2 or higher.

RESULTS

The mean age was 56.50 (standard deviation ±15.58) and median parity was 2 (range 0-6). A mild positive correlation was demonstrated between levator ani deficiency category and prolapse stage (rs=0.44; P<.001). Score distribution significantly differed by prolapse stage (P<.001). No patients with stage 3 prolapse had a levator ani score less than 6, and no patients with stage 4 prolapse had a levator ani score less than 9. In patients with prolapse, those with moderate levator ani deficiency had 3.2 times the odds of POP compared with patients with a minimal defect; those with severe levator ani deficiency had 6.4 times the odds of prolapse than those with minimal deficiency.

CONCLUSIONS

Levator ani deficiency severity is associated with clinically significant prolapse.

LEVEL OF EVIDENCE

II.