Yu Chun Hung, Chan Symphorosa Shing Chee, Cheung Rachel Yau Kar, Chung Tony Kwok Hung
Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, SAR, Hong Kong.
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, Hong Kong.
Int Urogynecol J. 2018 May;29(5):729-733. doi: 10.1007/s00192-017-3454-9. Epub 2017 Aug 24.
Levator ani muscle (LAM) avulsion is associated with pelvic organ prolapse (POP). There is limited information on the prevalence of LAM avulsion in Chinese women with POP. This study evaluated the prevalence of LAM avulsion in women presenting with POP and the effects on their quality of life (QoL).
This prospective study was conducted in a tertiary urogynecology center. Chinese women presenting with POP were recruited and completed standardized questionnaires exploring their symptoms and QoL and underwent gynecological examination to assess the stage of POP and involved compartments. Four-dimensional translabial ultrasound (US) was performed on all women, and evaluation of LAM avulsion was done offline.
Three hundred and ninety-eight women completed the study. The prevalence of LAM avulsion was 38.9% [95% confidence interval (CI) 34.1-43.7%]; 31 (7.8%), 26 (6.5%), and 98 (24.6%) had left, right, and bilateral LAM avulsion, respectively. LAM avulsion was associated with a more advanced stage of prolapse (P < 0.005) and prolapse of stage ≥II of all three compartments. Bilateral LAM avulsion was associated with a more severe stage of prolapse. More women with LAM avulsion reported bothersome symptoms of prolapse and had higher Pelvic Organ Prolapse Distress Inventory (POPDI) and Urinary Incontinence Questionnaire (UIQ) scores, implying more impairment in QoL. However, after multivariate linear regression analysis, POP stage remained a significant predictor of POPDI and UDI scores (P ≤ 0.006); LAM avulsion was not a predictor (P = 0.2 and 0.27, respectively).
LAM avulsion was detected in 39% of Chinese women with POP. It was associated with a more advanced POP stage, and these women had more impairment of QoL. However, LAM avulsion was not an independent factor influencing the QoL of these women.
肛提肌（LAM）撕裂与盆腔器官脱垂（POP）相关。关于中国POP女性中LAM撕裂的患病率信息有限。本研究评估了POP女性中LAM撕裂的患病率及其对生活质量（QoL）的影响。
本前瞻性研究在一家三级泌尿妇科中心进行。招募患有POP的中国女性，她们完成了探索其症状和QoL的标准化问卷，并接受妇科检查以评估POP的阶段和受累腔室。对所有女性进行经阴唇四维超声（US）检查，并离线评估LAM撕裂情况。
398名女性完成了研究。LAM撕裂的患病率为38.9%[95%置信区间（CI）34.1 - 43.7%]；分别有31名（7.8%）、26名（6.5%）和98名（24.6%）存在左侧、右侧和双侧LAM撕裂。LAM撕裂与更高级别的脱垂阶段相关（P < 0.005）以及所有三个腔室的≥II期脱垂。双侧LAM撕裂与更严重的脱垂阶段相关。更多LAM撕裂的女性报告有令人烦恼的脱垂症状，并且盆腔器官脱垂困扰量表（POPDI）和尿失禁问卷（UIQ）得分更高，这意味着QoL受损更严重。然而，经过多变量线性回归分析后，POP阶段仍然是POPDI和UDI得分的显著预测因素（P≤0.006）；LAM撕裂不是预测因素（分别为P = 0.2和0.27）。
在39%的中国POP女性中检测到LAM撕裂。它与更高级别的POP阶段相关，并且这些女性的QoL受损更严重。然而，LAM撕裂不是影响这些女性QoL的独立因素。
