Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement?

Objective Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh. Methods This was a retrospective analysis of data obtained from three surgical audits for subjective and objective outcomes following anterior colporrhaphy with mesh. Recurrence was defined as cystocele ≥ Stage 2 on the prolapse quantification system of the International Continence Society; symptoms of vaginal lump/bulge; or cystocele on ultrasound, defined as maximum bladder descent to ≥ 10 mm below the symphysis pubis. Levator avulsion was diagnosed using tomographic ultrasound imaging. Results Two hundred and nine patients were followed up at a mean of 2.2 years (range, 3 months to 5.6 years) after anterior vaginal mesh placement. 24% (51/209) had recurrent prolapse symptoms, 33% (68/209) clinical cystocele recurrence ≥ Stage 2, and 26% (54/209) a recurrent cystocele on ultrasound. Twenty‐eight out of 80 (35%) women with levator avulsion had significant sonographic cystocele recurrence (odds ratio ( OR ), 2.24 (95% confidence interval ( CI ), 1.13–4.43)). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression ( OR , 2.13 (95% CI , 1.04–4.39); P = 0.04). Conclusion Levator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.