Oversand Sissel H, Staff Anne C, Sandvik Leiv, Volløyhaug Ingrid, Svenningsen Rune
Department of Gynecology, Oslo University Hospital, Ullevål, Pb 4956 Nydalen, 0424, Oslo, Norway.
Department of Clinical Medicine, University of Oslo, Oslo, Norway.
Int Urogynecol J. 2018 Jan;29(1):63-69. doi: 10.1007/s00192-017-3390-8. Epub 2017 Jun 15.
The aims of this study were to evaluate the prevalence of levator ani muscle (LAM) avulsions in a selected cohort of patients with primary anterior compartment pelvic organ prolapse (POP) and to assess whether LAM avulsions, as an independent factor, affect the degree of POP symptoms and sexual dysfunction. Additionally, clinical and demographic variables of women with and those without avulsions were compared.
We carried out a cross-sectional analysis of a prospective cohort study including 197 women scheduled for anterior compartment POP surgery. LAM avulsions were diagnosed on transperineal 4D ultrasound. Preoperative symptom severity and sexual dysfunction were evaluated using validated questionnaires (Pelvic Floor Disability Index [PFDI-20] and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form 12 [PISQ-12]). Linear regression was performed with avulsion as the main independent variable against total PFDI-20 and domain scores, bulge symptoms, and PISQ-12 score. Clinical and demographic variables for women with and without avulsions were compared using independent samples t test, Mann-Whitney U test or Chi-squared test.
The prevalence of LAM avulsions was 50.3%. Avulsions were not associated with symptom severity or sexual dysfunction. "Chronic disease causing pain, fatigue or increased intra-abdominal pressure" was the only independent factor associated with all domains of the PFDI-20. Women with avulsions were younger at presentation, older at their first delivery, had lower BMI, and more often had a history of forceps delivery (p < 0.01).
LAM avulsions were highly prevalent in this preoperative POP cohort. Avulsions were not associated with the severity of POP symptoms or sexual dysfunction. Women with avulsions seem to require fewer additional cofactors for developing POP.
本研究旨在评估特定队列中患有原发性前盆腔脏器脱垂（POP）患者的肛提肌（LAM）撕裂发生率，并评估LAM撕裂作为一个独立因素是否会影响POP症状的严重程度和性功能障碍。此外，还比较了有和没有撕裂的女性的临床和人口统计学变量。
我们对一项前瞻性队列研究进行了横断面分析，该研究包括197名计划接受前盆腔脏器脱垂手术的女性。通过经会阴四维超声诊断LAM撕裂。使用经过验证的问卷（盆底功能障碍指数[PFDI-20]和盆腔脏器脱垂/尿失禁性功能问卷简表12[PISQ-12]）评估术前症状严重程度和性功能障碍。以撕裂作为主要自变量，对总PFDI-20和各领域得分、膨出症状以及PISQ-12得分进行线性回归分析。使用独立样本t检验、曼-惠特尼U检验或卡方检验比较有和没有撕裂的女性的临床和人口统计学变量。
LAM撕裂的发生率为50.3%。撕裂与症状严重程度或性功能障碍无关。“导致疼痛、疲劳或腹内压升高的慢性疾病”是与PFDI-20所有领域相关的唯一独立因素。有撕裂的女性就诊时年龄较小，首次分娩时年龄较大，BMI较低，且更常有产钳分娩史（p<0.01）。
在这个术前POP队列中，LAM撕裂非常普遍。撕裂与POP症状的严重程度或性功能障碍无关。有撕裂的女性似乎在发生POP时需要较少的其他辅助因素。
