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Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence

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Abstract

Introduction and hypothesis

Native tissue vaginal repairs are associated with relatively high levels of recurrence. Systematic reviews have noted that preoperative pelvic floor muscle strength was associated with increased risk of recurrence in the short term.

Methods

This is a retrospective review of patients who underwent a primary reconstructive surgery for anterior compartment vaginal prolapse between 2001 and 2015. Patients were divided into “absent,” “weak” and “good” preoperative PFM strength (aPFM, wPFM and gPFM, respectively) based on a modified Oxford scale. Failure rates were determined by a composite of subjective and objective anatomic outcomes. Subjects who underwent re-operations or procedures for recurrent prolapse of the anterior compartment were considered failures. A p value < 0.05 was considered statistically significant.

Results

Two hundred ninety-nine patients were included. The aPFM (n = 36), wPFM (n = 115) and gPFM (n = 148) groups had similar descriptive statistics, except subjects in the aPFM and wPFM groups were significantly older than the gPFM group (p = 0.008). All groups underwent similar reconstructive surgeries. Average length of follow-up of 143.9 weeks (41 to 717 weeks) was similar among the three groups (p = 0.472). For the primary outcome of composite failure, aPFM had significantly more anterior vaginal wall recurrences than both the wPFM and gPFM groups, 13.89% vs. 3.48% and 4.05%, respectively (p = 0.033).

Conclusions

Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.

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Acknowledgements

We acknowledge Alexandriah Alas, MD, for assistance with statistical analysis.

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Authors and Affiliations

  1. Department of Gynecology-Section of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Jeffrey S. Schachar, Hemikaa Devakumar, Laura Martin, Eric A. Hurtado & G. Willy Davila

  2. Department of Gynecology-Section of Minimally Invasive Gynecologic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Sara Farag

Authors
  1. Jeffrey S. Schachar
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  2. Hemikaa Devakumar
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  3. Laura Martin
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  6. G. Willy Davila
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Corresponding author

Correspondence to Jeffrey S. Schachar.

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Conflicts of interest

Dr. Schachar: None.

Dr. Devakumar: None.

Dr. Martin: None.

Dr. Farag: None.

Dr. Hurtado: Sponsored research: Acell, Alma Laser, Coloplast, Cook Biomedical.

Dr. Davila: Research grant: Acell, Coloplast, Cook Biomedical, Pfizer. Speaker: Alma Lasers, Astellas.

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Schachar, J.S., Devakumar, H., Martin, L. et al. Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence. Int Urogynecol J 29, 1661–1667 (2018). https://doi.org/10.1007/s00192-018-3626-2

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  • DOI: https://doi.org/10.1007/s00192-018-3626-2

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