Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway.
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Int Urogynecol J. 2022 Oct;33(10):2879-2885. doi: 10.1007/s00192-022-05168-8. Epub 2022 Mar 28.
The objective was to explore the impact of levator ani muscle (LAM) trauma and pelvic floor contraction on symptoms and anatomy after pelvic organ prolapse (POP) surgery.
Prospective study including 200 women with symptomatic POP ≥ grade 2 examined 3 months prior to and 6 months after surgery. Prolapse in each compartment was graded using the Pelvic Organ Prolapse Quantification (POP-Q) system, and women answered yes/no to a question about bulge sensation. Pelvic floor muscle contraction was assessed with transperineal ultrasound measuring proportional change in levator hiatal anteroposterior diameter from rest to contraction. LAM trauma was diagnosed using tomographic ultrasound imaging. Statistical analysis was performed using multivariate logistic regression analysis.
A total of 183 women (92%) completed the study. Anatomical recurrence (POP ≥ grade 2) was found in 76 women (42%), and a bulge sensation was reported by 35 (19%). Ninety-two women (50%) had LAM trauma, and this was associated with increased risk of anatomical recurrence (OR 2.1 (95% CI 1.1-4.1), p = 0.022), but not bulge sensation (OR 1.1 (95% CI 0.5-2.4), p = 0.809). We found a reduced risk of bulge sensation for women with absent to weak contraction compared with normal to strong contraction (OR 0.4 (95% CI 0.1-0.9), p = 0.031), but no difference in risk for POP ≥ 2 after surgery (OR 1.5 (95% CI 0.8-2.9), p = 0.223).
Levator ani muscle trauma was associated with increased risk of anatomical failure 6 months after POP surgery. Absent to weak pelvic floor muscle contraction was associated with reduced risk of bulge sensation after surgery.
本研究旨在探讨肛提肌（LAM）损伤和盆底收缩对盆腔器官脱垂（POP）手术后症状和解剖结构的影响。
本前瞻性研究纳入了 200 例症状性 POP≥2 级的女性患者，分别在术前 3 个月和术后 6 个月进行检查。采用盆腔器官脱垂定量（POP-Q）系统对每个盆腔器官脱垂部位进行分级，并采用会阴超声测量静息状态至收缩状态时肛提肌裂孔前后径的比例变化评估盆底肌肉收缩情况。采用断层超声成像技术诊断肛提肌损伤。采用多变量逻辑回归分析进行统计学分析。
共有 183 例（92%）患者完成了研究。76 例（42%）患者存在解剖学复发（POP≥2 级），35 例（19%）患者有膨出感。92 例（50%）患者存在肛提肌损伤，与解剖学复发风险增加相关（OR 2.1（95%CI 1.1-4.1），p=0.022），但与膨出感无关（OR 1.1（95%CI 0.5-2.4），p=0.809）。与正常至强烈收缩相比，收缩无力或无收缩的女性膨出感风险降低（OR 0.4（95%CI 0.1-0.9），p=0.031），但术后 POP≥2 的风险无差异（OR 1.5（95%CI 0.8-2.9），p=0.223）。
POP 术后 6 个月，肛提肌损伤与解剖学失败风险增加相关。盆底肌肉收缩无力或无收缩与术后膨出感风险降低相关。
