Table 4.
POP anatomy and symptoms in women assessed for pubovisceral avulsions
| First author | n with levator avulsion | Percentage of women of study population with levator avulsion | Conclusion | |
|---|---|---|---|---|
| Abdool [29] | Bilateral | 31 | 9 % | Cystocele and rectocele (on POP-Q) were associated with both unilateral and bilateral avulsion. Uterine prolapse was only related to bilateral avulsion |
| Unilateral | 45 | 12 % | ||
| Adekanmi [23] | Cases: | Women with symptomatic POP ≥ stage II showed in 56 % of the cases a partial or complete avulsion. No avulsions were identified in nulliparous women | ||
| Partial | 18 | 26 % | ||
| Complete | 21 | 30 % | ||
| Controls | 0 | 0 % | ||
| DeLancey [13] | Cases: | Major avulsions were statistically significant related to POP status (p < 0.001) and associated with an adjusted OR of 7.3 (95 % CI 3.9–13.6) | ||
| Major | 83 | 55 % | ||
| Minor | 24 | 16 % | ||
| Controls: | ||||
| Major | 21 | 16 % | ||
| Minor | 30 | 22 % | ||
| Dietz [14] | Complete | 181 | 23 % | Women with complete avulsions were twice as likely to have significant POP, especially cystocele and uterine prolapse |
| Dietz [38] | Complete | 21 | 20 % | Women with a palpated avulsion showed more cystocele descent both on ultrasound and on POP-Q |
| Dietz [17] | Complete | 46 | 14 % | Women with complete avulsions had higher grades of POP of the anterior and central compartment. There was no association between complete avulsion and POP symptoms |
| Dietz [31] | Complete | 50 | 19 % | Defect score was associated with cystocele and uterine prolapse and POP symptoms |
| Dietz [33] | Complete | 104 | 25 % | Women with a complete avulsion were more likely to have POP of the anterior compartment (p < 0.001) |
| Dietz [22] | Complete | 226 | 30 % | A complete avulsion was strongly associated with symptoms of POP, significant POP on clinical assessment, and bladder descent on perineal ultrasonography (all p < 0.001) |
| Heilbrun [24] | Major | 20 | 10 % | POP-Q points Ba and Bp were more often at or below the hymen in women with major avulsions compared to women with no or minor avulsions |
| Morgan [28] | Major | 46 | 55 % | There was no difference in preoperative anterior, apical, and posterior POP-Q data between women with and without a major avulsion |
POP pelvic organ prolapse, n number of patients, POP-Q Pelvic Organ Prolapse Quantification, p value p value for difference between avulsion and outcome measure assessed, OR odds ratio, 95 % CI 95 % confidence interval, Ba and Bp most descended edge of anterior and posterior vaginal wall, respectively, relative to the hymen