OC18.05: Surgical Outcome in Women with Advanced Stage of Pelvic Organ Prolapse: Levator Ani Muscle Avulsion and Mesh Application

Mesh repair surgery, compared with native tissue repair, was associated with lower risk of recurrence of prolapse in women with Stage III/IV pelvic organ prolapse (POP). In women with concomitant levator ani muscle (LAM) avulsion, mesh repair surgery was associated with a four-fold reduction in recurrence of POP. As such, women with advanced stage of prolapse were offered with option of mesh operation only when had LAM avulsion. This study aims to evaluate the surgical outcome of women under this local protocol. Women presented with Stage III/IV POP and received primary prolapse surgery under this local protocol in 2020-22 were reviewed. LAM avulsion was assessed by transperineal ultrasound. Women had LAM avulsion were counselled on either native tissue or mesh repair while women had intact LAM were counselled on native tissue repair only. Subjective recurrence of POP was defined as symptoms of prolapse reported by the patient. Objective recurrence was defined as POP-Q≥Stage II. Total of 189 women were reviewed within study period, 167 with their postoperative information available. The mean age (67.3) and median parity (3) were similar in mesh and non-mesh group. Mean follow-up time were 13.9 for non-mesh group and 16.9 for mesh group (P < 0.01). Among them, 100 women had LAM avulsion and 79 of them underwent mesh operation, either sacrocolpopexy or vaginal mesh repair. Subjective and objective recurrence rates were as listed. Women with LAM avulsion were found to have lower subjective recurrence, although not reach but towards statistical significant. Women with advanced stage of prolapse and LAM avulsion had lower subjective recurrence rate when received mesh repair in mean of 15 months of follow-up. Mesh repair N = 79 Native tissue repair N = 21