Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: A 2-year follow-up study
Open accessAbstract
INTRODUCTION AND HYPOTHESIS: This study aimed to determine the relationship of recurrent cystocele with avulsion of puborectalis muscle and other risk factors. METHODS: In this prospective observational cohort study, 245 women undergoing anterior colporrhaphy were invited for a 2-year follow-up visit consisting of a questionnaire, physical examination, and translabial 3D ultrasonography. Women with and without recurrent cystocele were compared to identify recurrence risk factors. RESULTS: Of the 245 women, 156 agreed to the follow-up visit (63.7%). Objective recurrence rate was 80 of 156 (51.3%). Seventeen of the 156 (10.9%) reported subjective recurrence. Risk factors for anatomical recurrence were complete avulsion of puborectalis muscle (OR, 2.4; 95% CI, 1.3, 4.7), advanced preoperative stage (OR, 2.0; 95% CI, 1.0, 4.1), family history of prolapse (OR, 2.4; 95% CI, 1.2, 4.9), and sacrospinous fixation (OR, 6.5; 95% CI, 2.0, 21.2). CONCLUSIONS: Risk factors for anatomical cystocele recurrence after anterior colporrhaphy were complete avulsion of puborectalis muscle, advanced preoperative stage, family history of prolapse, and sacrospinous fixation.
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For prolapse recurrence, parity per 1 was not statistically significant (n=2, pooled OR 0.96; 95% CI 0.76-1.2).
“For prolapse recurrence, parity per 1 was not statistically significant (n¼2, pooled OR, 0.96; 95% CI, 0.76e1.2).”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [17]
Results, Table 4 (page not supplied) reports that parity was not significantly associated with anatomical cystocele recurrence (OR 0.9, 95% CI 0.7–1.2; p = 0.61). This is a single-study estimate, not the claimed two-study pooled OR of 0.96 (95% CI 0.76–1.2). (LLM, conf=0.88)
Experimental — accuracy not yet measuredConstipation was reported by 3 studies and was not statistically significant for pelvic organ prolapse recurrence (n=3, OR 0.95; 95% CI 0.67-1.36).
“Constipation was reported by 3 studies and was not statistically significant (n¼3, OR, 0.95; 95% CI, 0.67e1.36)”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [17]
Table 4 (Results) reports that constipation was not significantly associated with anatomical cystocele recurrence in this study (OR 1.0, 95% CI 0.4–2.3; p=0.99). It does not report a three-study pooled estimate or the claimed OR of 0.95 (95% CI 0.67–1.36). (LLM, conf=0.90)
Experimental — accuracy not yet measuredFor pelvic organ prolapse recurrence, BMI was not statistically significant as a continuous variable (n=3, pooled OR 0.98; 95% CI 0.93-1.03).
“nor as a continuous variable (n¼3, pooled OR, 0.98; 95% CI, 0.93e1.03).”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [17]
Results Table 4 reports that BMI was not significantly associated with anatomical cystocele recurrence (OR 1.0, 95% CI 0.9–1.1; p=0.56). This is a single-study estimate, not the claimed pooled estimate from three studies (OR 0.98, 95% CI 0.93–1.03). (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor pelvic organ prolapse recurrence, age per 1 year was not statistically significant (n=3, pooled OR 1.01; 95% CI 0.99-1.03).
“For POP recurrence, age per 1 year was not statistically significant (n¼3, pooled OR, 1.01; 95% CI, 0.99e1.03).”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [17]
The Results (Table 4) report that age was not a statistically significant risk factor for anatomical cystocele recurrence (N=156; p=0.83), and the Discussion states this explicitly. The paper reports a single-study odds ratio of 1.0, not a three-study pooled OR of 1.01 (95% CI 0.99–1.03); its outcome is also specifically cystocele recurrence rather than POP recurrence generally. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOne study showed sacrospinous hysteropexy to be a significant risk factor for prolapse recurrence.
“and 1 showed sacrospinous hysteropexy to be a significant risk factor.”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [17]
The Results report that sacrospinous fixation was independently associated with anatomical cystocele recurrence after anterior colporrhaphy (OR 6.5; 95% CI 2.0–21.2). The paper does not identify the procedure as sacrospinous hysteropexy or establish a risk for prolapse recurrence more broadly; the Discussion also notes that few patients underwent fixation and the estimate was imprecise. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Regarding prolapse recurrence, levator defect was a statistically significant risk factor in the study by Weemhoff et al, but in the combined study with another database, the odds ratio was no longer statistically significant.
“Regarding POP recurrence, levator defect was a statistically significant risk factor in the study by Weemhoff et al, 17 but in the combined study with the results of another database, 44 the OR was no longer statistically significant.”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [17]
In the study by Weemhoff et al., a complete levator defect, SSF, a positive family history, and a higher preoperative POP stage were found to be independent risk factors for anatomical recurrence.
“In the study by Weemhoff et al. [5], a complete levator defect, SSF, a positive family history, and a higher preoperative POP stage were found to be independent risk factors for anatomical recurrence.”
From The External Validation of a Multivariable Prediction Model for Recurrent Pelvic Organ Prolapse After Native Tissue Repair: A Prospective Cohort Study (2025) · cites this paper as [5]
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References 31 · Cited by 137
- Authors
- Weemhoff, M., Vergeldt, T. F. M., Notten, K., Serroyen, J., Kampschoer, P. H. N. M., & Roumen, F. J. M. E.
- Affiliations
- Maastricht University Medical Centre (NL)
- Maastricht University (NL)
- Atrium Medisch Centrum Parkstad (NL)
- Corresponding author
- Weemhoff, Mirjam
- Venue
- International Urogynecology Journal
- Published
- 2011-08-06
- Volume
- 23
- Issue
- 1
- Pages
- 65-71
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- PMC
- PMC3251779
- OpenAlex
- W1966863209
- Cited by
- 137
- References
- 31
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 3 · 2018: 4 · 2017: 11 · 2016: 15 · 2015: 15 · 2014: 18 · 2013: 18 · 2012: 12
- FWCI
- 12.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- International Urogynecology Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- cystocele recurrence, anterior colporrhaphy, pelvic organ prolapse, risk factors, sacrospinous ligament fixation
- MeSH terms
- Aged, Female, Follow-Up Studies, Humans, Middle Aged, Prospective Studies, Surveys and Questionnaires, Recurrence, Risk Factors, Sacrococcygeal Region, Severity of Illness Index, Ultrasonography, Vagina, Single-Blind Method, Muscle, Skeletal, Imaging, Three-Dimensional, Cystocele
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