Does levator ani injury affect cystocele type?

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Anatomical Imaging

Background:

• Cystocele classification and its association with levator ani muscle injury are not fully understood.
• Existing theories suggest central fascial defects cause certain cystocele types.

Purpose of the Study:

• To investigate the prevalence of levator ani injury in different cystocele types defined by translabial ultrasound.
• To explore potential pathophysiological mechanisms underlying cystocele development.

Main Methods:

• Retrospective analysis of 222 women with physical examination, urodynamic testing, and 4D pelvic floor ultrasound.
• Classification of cystoceles below the symphysis pubis into Green II (cystourethrocele) or Green III (intact RVA) using ultrasound parameters.
• Blinded evaluation of prolapse, hiatal dimensions, and levator ani trauma.

Main Results:

• Of 102 women with cystocele below the symphysis pubis, 63 had Green II and 39 had Green III.
• Green III cystocele patients were older, had more severe prolapse, and higher rates of objective voiding dysfunction.
• Green III cystoceles were associated with larger hiatal dimensions and significantly more levator ani muscle avulsions (69% vs. 35%).

Conclusions:

• Cystocele with an intact retrovesical angle (Green III) is more likely associated with levator ani muscle avulsion.
• This association suggests birth-related trauma as a primary cause for Green III cystoceles.
• Findings contradict the belief that such cystoceles result from central, rather than lateral, fascial defects.