Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study
Abstract Introduction Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1 year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligam...
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Wiley
2025-06-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.15102 |
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| author | Sissel Hegdahl Oversand Anne Cathrine Staff Ingrid Volløyhaug Rune Svenningsen |
| author_facet | Sissel Hegdahl Oversand Anne Cathrine Staff Ingrid Volløyhaug Rune Svenningsen |
| author_sort | Sissel Hegdahl Oversand |
| collection | DOAJ |
| description | Abstract Introduction Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1 year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligament suspension and perineal repair). The aim of the present study was to compare women with and without levator ani muscle avulsions in terms of patient‐reported and anatomical outcomes, and failure rates in the same cohort after 5 years. Material and Methods Five‐year prospective cohort study of 143 women operated on for anterior and/or mid‐compartment pelvic organ prolapse with the Manchester procedure between October 2014 and January 2017, Clinical Trial study number NCT02246387. Levator ani muscle avulsions (uni‐ or bilateral) were diagnosed at inclusion by transperineal ultrasound. Primary outcome at 5‐year follow‐up was subjective bulge symptoms (question 3, Pelvic Floor Distress Inventory‐20). Secondary outcomes were total score from the same questionnaire, sexual distress (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire‐12), subjective cure, Pelvic Organ Prolapse Quantification scale measurements, defining optimal outcomes as anterior compartment stage <0–1 and mid‐compartment point C ≤−5, and new surgical or conservative prolapse treatment. Results Among 143 women followed up after 5 years, the avulsion rate was 52.4%. Both groups showed similar reductions in bulge symptoms, pelvic floor symptoms, and anatomical anterior‐ and mid‐compartment measurements. Sexual distress improvement was significantly greater for women with avulsion (Mean change difference: −3.4 (−6.4 to −0.5)). Multivariate regression revealed no significant effect of avulsion on symptom scores, cure rates, or need for new prolapse treatment. Women with avulsion had half the odds of obtaining an optimal anterior compartment outcome compared to those without avulsion (adjusted odds ratio: 0.5 (0.2–0.9)). Conclusions Although women with levator ani muscle avulsion had lower odds of achieving an optimal anterior compartment outcome, the overall anatomical changes from preoperative to 5 years were similar in both groups. Importantly, avulsion did not impact symptom improvement, patient‐reported outcomes, or the need for further treatment. These findings support the Manchester procedure as an effective and durable surgical option for women with POP, regardless of avulsion status. |
| format | Article |
| id | doaj-art-8066a1d09dea4b92adca9d3decb8a188 |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-8066a1d09dea4b92adca9d3decb8a1882025-08-20T03:22:12ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122025-06-0110461200120610.1111/aogs.15102Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up studySissel Hegdahl Oversand0Anne Cathrine Staff1Ingrid Volløyhaug2Rune Svenningsen3Department of Obstetrics and Gynecology Oslo University Hospital Oslo NorwayDepartment of Obstetrics and Gynecology Oslo University Hospital Oslo NorwayFaculty of Medicine and Health Sciences Norwegian University of Science and Technology (NTNU) Trondheim NorwayDepartment of Obstetrics and Gynecology Oslo University Hospital Oslo NorwayAbstract Introduction Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1 year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligament suspension and perineal repair). The aim of the present study was to compare women with and without levator ani muscle avulsions in terms of patient‐reported and anatomical outcomes, and failure rates in the same cohort after 5 years. Material and Methods Five‐year prospective cohort study of 143 women operated on for anterior and/or mid‐compartment pelvic organ prolapse with the Manchester procedure between October 2014 and January 2017, Clinical Trial study number NCT02246387. Levator ani muscle avulsions (uni‐ or bilateral) were diagnosed at inclusion by transperineal ultrasound. Primary outcome at 5‐year follow‐up was subjective bulge symptoms (question 3, Pelvic Floor Distress Inventory‐20). Secondary outcomes were total score from the same questionnaire, sexual distress (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire‐12), subjective cure, Pelvic Organ Prolapse Quantification scale measurements, defining optimal outcomes as anterior compartment stage <0–1 and mid‐compartment point C ≤−5, and new surgical or conservative prolapse treatment. Results Among 143 women followed up after 5 years, the avulsion rate was 52.4%. Both groups showed similar reductions in bulge symptoms, pelvic floor symptoms, and anatomical anterior‐ and mid‐compartment measurements. Sexual distress improvement was significantly greater for women with avulsion (Mean change difference: −3.4 (−6.4 to −0.5)). Multivariate regression revealed no significant effect of avulsion on symptom scores, cure rates, or need for new prolapse treatment. Women with avulsion had half the odds of obtaining an optimal anterior compartment outcome compared to those without avulsion (adjusted odds ratio: 0.5 (0.2–0.9)). Conclusions Although women with levator ani muscle avulsion had lower odds of achieving an optimal anterior compartment outcome, the overall anatomical changes from preoperative to 5 years were similar in both groups. Importantly, avulsion did not impact symptom improvement, patient‐reported outcomes, or the need for further treatment. These findings support the Manchester procedure as an effective and durable surgical option for women with POP, regardless of avulsion status.https://doi.org/10.1111/aogs.15102gynecologic surgical procedurespelvic organ prolapsephysiologicalrecurrencesexual dysfunctiontreatment outcome |
| spellingShingle | Sissel Hegdahl Oversand Anne Cathrine Staff Ingrid Volløyhaug Rune Svenningsen Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study Acta Obstetricia et Gynecologica Scandinavica gynecologic surgical procedures pelvic organ prolapse physiological recurrence sexual dysfunction treatment outcome |
| title | Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study |
| title_full | Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study |
| title_fullStr | Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study |
| title_full_unstemmed | Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study |
| title_short | Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5‐year follow‐up study |
| title_sort | impact of levator ani muscle avulsions on manchester procedure outcomes a 5 year follow up study |
| topic | gynecologic surgical procedures pelvic organ prolapse physiological recurrence sexual dysfunction treatment outcome |
| url | https://doi.org/10.1111/aogs.15102 |
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