Status Plus

abstract

154 - DOES LEVATOR ANI MUSCLE INJURY AFFECT THE EFFICACY OF VAGINAL PESSARY IN WOMEN WITH PELVIC ORGAN PROLAPSE

154

DOES LEVATOR ANI MUSCLE INJURYAFFECT THE EFFICACY OF VAGINAL PESSARY IN WOMEN WITH PELVIC ORGANPROLAPSE

R. CHEUNG1, L. LEE 2,S. CHAN 3;
1Department of Obstetrics &Gynecology, Prince of Wales Hosp., Hong Kong, Hong Kong, 2TheChinese Univ. of Hong Kong, Hong Kong, Hong Kong, 3ChineseUniv. of Hong Kong, Shatin, Hong Kong.

Introduction: Vagina pessary hasbeen long used for treating pelvic organ prolapse. It is an effectivetreatment to relieve prolapse symptoms in women with different stagesof prolapse (1, 2). Presence of levator ani muscle injury has beenrecently shown to increase the likelihood of vaginal pessarydislodgment by threefold (2). Scare information is available whetherthe efficacy of vaginal pessary associates with the presence oflevator ani muscle injury.
Objective: We aimed to assesswhether the effect of vaginal pessary is modified by the presence oflevator ani muscle injury.
Methods: An observational studywas conducted in women who presented with pelvic organ prolapse andreceived vaginal pessary from 2011 to 2013. All of them have detailhistory taking and physical examination using POPQ system before thevaginal pessary. 3D/4D transperineal ultrasound scan was performedand the levator ani muscle injury was assessed using tomographicultrasound imaging on volumes obtained at maximal PFMC at 2.5mmslices intervals, from 5mm below to 12.5mm above the plane of minimalhiatal dimensions. They were followed up in our clinic at 12 monthsafterwards. Their symptoms and POP-Q staging were reassessed. Thesymptoms and quality of life using Pelvic floor distress inventory(PFDI) and Pelvic floor impact questionnaires (PFIQ) were comparedbetween women with and without levator ani muscle injury.
Results:In total, 130 women were assessed. The mean age at recruitment was63.3 years old (SD 9.2 years) and mean body mass index (BMI) was 25.3kg/m2 (SD 3.6 kg/m2). 106 (81.5%) of women were diagnosedStage I or II pelvic organ prolapse while 24 (18.5%) had Stage III orIV prolapse. 6 (4.6%) of them had vaginal vault prolapse. 95 (73.1%)women had intact levator ani muscle while 35 (26.9%) of them hadlevator ani muscle injury. The PFDI and PFIQ scores at baseline and12 months after pessary used were not significantly different betweenwomen with or without levator ani muscle injury as shown in Table 2.POPDI and POPIQ scores were significant improved after pessaryinsertion in both groups (P<0.01). The mean difference of thescores were also compared between two groups and the difference werehigher in POPDI and POPIQ scores in women with levator ani muscleinjury although they did not reach statistical significance (P=0.39and P=0.41).
Conclusions: Women with pelvic organ prolapseshowed significantly improvement in their prolapse symptoms aftervaginal pessary inserted for 1 year. The improvement is similar inwomen with or without levator ani muscle injury.
References:1) Pessaries (mechanical devices) for pelvic organ prolapse in women.Cochrane Database Syst Rev 2013.2) Vaginal pessary in women withsymptomatic pelvic organ prolapse: A randomized controlled trial.Obstet Gynecol 2016.3) Levator ani muscle avulsion is a risk factorfor vaginal pessary expulsion within 1 year for pelvic organprolapse. Ultrasound Obstet Gynecol 2017 ( Epub ahead of print)


Table1. Characteristics in women with or without levator ani muscleinjury.


NoLAM injury (n=95)

LAMinjury (n=35)

Pvalue

Ageat recruitment ( years old)

63.2(9.0)

63.5(9.8)

0.34

BodyMass Index (kg/m2)

25.1(3.7)

25.7(3.2)

0.65

Parity

3.0(1.6)

3.0(1.4)

0.24

Numberof vaginal delivery

3.0(1.7)

3.0(1.4)

0.82

Menopaused

80(84.2%)

29(82.9%)

0.52

Sexuallyactive

32(35.6%)

9(25.7%)

0.40

Stagingof prolapse




StageI-II prolapse

83(87.4%)

23(65.7%)

0.01

StageIII-IV prolapse

12(12.6%)

12(34.3%)


LAM=levator ani muscle Data is presented in Mean (Standard deviation)or Number (percentage).


Table2. The PFDI and PFIQ scores of women with and without levator animuscle injury.


NoLAM injury (N=95)

LAMinjury (N=35)

Pvalue**


Baseline

12months

Meandifference

Baseline

12months

Meandifference


PFDI-POPDI

76.2(60.7)

41.7(53.1)*

34.5(24.3-44.7)

73.0(60.5)

46.7(54.5)*

26.3(7.9-45.9)

0.39

PFDI-UDI

61.1(45.4)

41.6(43.9)*

19.5(12.2-26.9)

61.0(55.5)

47.0(47.8)*

14.0(0.5-28.7)

0.22

PFDI-CRADI

54.7(54.0)

43.9(55.4)*

10.8(2.1-19.4)

54.7(54.6)

44.3(54.9)

10.4(-7.1-28.5)

0.12

PFIQ-POPIQ

47.2(61.6)

21.7(54.6)*

25.5(12.2-38.8)

45.1(65.1)

23.1(59.6)*

22.0(1.9-44.0)

0.41

PFIQ-UIQ

42.4(64.2)

29.7(52.9)*

12.7(2.2-23.1)

35.1(63.3)

32.2(58.9)

2.9(-15.6-22.7)

0.43

PFIQ-CRAIQ

17.1(42.6)

14.3(50.6)

2.8(-6.3-12.1)

17.1(47.6)

14.6(48.6)

2.5(-7.0-12.2)

0.42

LAM=levator ani muscle Scores are presented with Mean (Standarddeviation) *significant difference between baseline and 12 monthsscores by paired T-test ** comparison of the mean difference ofthe scores among two groups by T-test