Department of Gynecology, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Obstet Gynecol Scand. 2019 Aug;98(8):1046-1054. doi: 10.1111/aogs.13604. Epub 2019 Apr 2.
Levator ani muscle avulsions potentially increase recurrence after anterior colporrhaphies. We aimed at evaluating the impact of avulsions on anatomical and patient-reported outcomes 1 year after the Manchester procedure for primary anterior compartment pelvic organ prolapse.
Prospective cohort study of 189 women undergoing the Manchester procedure between October 2014 and January 2017. Avulsions were diagnosed by transperineal ultrasound. Women with and without avulsions were compared for 1-year postoperative outcomes; Pelvic Organ Prolapse Quantification measurements, subjective satisfaction (1-worse to 4-cured), failure (new prolapse treatment), response to validated questionnaires on pelvic floor distress and sexual function, and a composite outcome (subjectively cured and optimal anterior compartment outcome (stage 0-I)). Optimal mid-compartment outcome was defined as cervix ≥5 cm above the hymen. Factors potentially associated with poor anatomical outcomes (anterior compartment stage ≥II) or pelvic floor distress were analyzed using regression analyses.
Fewer women with avulsions (present in 50.8%) obtained optimal mid-compartment outcomes (88.2% vs 77.1%; P = 0.05). The groups were otherwise similar in terms of mid-compartment reduction, anterior compartment results, failure rate, subjective satisfaction, pelvic floor/sexual symptoms, and combined optimal subjective and anatomical outcome. Only preoperative anterior compartment stage ≥III was associated with poor anatomical outcome (P < 0.01). A high preoperative symptom score was associated with a high postoperative symptom score (P < 0.001).
Although fewer women with avulsions obtained optimal mid-compartment results, avulsions had no impact on other anatomical or symptomatic outcomes 1 year after the Manchester procedure for primary anterior compartment prolapse.
肛提肌撕裂可能会增加前阴道修补术后的复发率。我们旨在评估 1 年后在原发性前盆腔器官脱垂行曼彻斯特手术时肛提肌撕裂对解剖和患者报告结果的影响。
对 2014 年 10 月至 2017 年 1 月期间行曼彻斯特手术的 189 名女性进行前瞻性队列研究。通过经会阴超声诊断撕裂。比较有撕裂和无撕裂的女性术后 1 年的结果；盆腔器官脱垂量化测量、主观满意度（1-最差至 4-治愈）、失败（新的脱垂治疗）、对盆底窘迫和性功能的有效问卷的反应，以及复合结果（主观治愈和最佳前盆腔结果（0 期-I 期））。最佳中盆腔结果定义为子宫颈高于处女膜 5cm 以上。使用回归分析分析与解剖学结果不良（前盆腔分期≥Ⅱ期）或盆底窘迫相关的潜在因素。
有撕裂的女性获得最佳中盆腔结果的比例较低（50.8% vs 77.1%；P=0.05）。两组在中盆腔缩小、前盆腔结果、失败率、主观满意度、盆底/性功能症状以及联合最佳主观和解剖学结果方面相似。只有术前前盆腔分期≥III 期与解剖学结果不良相关（P<0.01）。术前高症状评分与术后高症状评分相关（P<0.001）。
尽管有撕裂的女性获得最佳中盆腔结果的比例较低，但 1 年后在原发性前盆腔脱垂行曼彻斯特手术时，撕裂对其他解剖学或症状结果没有影响。
