Estimated levator ani subtended volume: a novel assay for predicting XXXX after uterosacral ligament suspension.

@entity1 @entity177
BACKGROUND: Levator ani muscle complex plays an important role in pelvic support and defects or laxity in this muscle complex contributes to pelvic organ prolapse and recurrence after surgical repair. OBJECTIVE: The purpose of this study was to determine whether estimated levator ani subtended volume can predict surgical outcomes for laparoscopic bilateral uterosacral ligament suspension. STUDY DESIGN: A retrospective cohort study was performed in @entity1 who underwent laparoscopic uterosacral ligament suspension from 2010-2012. Only @entity1 with a preoperative pelvic magnetic resonance image were included. @entity177 was defined as a composite score that included the presence of anatomic bulge beyond the hymen with sensation of vaginal bulge or repeat treatment for prolapse via pessary or surgery by 1-year follow-up evaluation. Standard protocol pelvic magnetic resonance imaging measurements pubococcygeal line, H-line, and M-line were collected along with the calculation of the width of the levator ani hiatus. Estimated levator ani subtended volume was calculated for each subject. An optimal cutoff point was calculated and compared against categoric values of surgical success/failure. A Fisher exact test, an area under receiver operating characteristics curve, and logistic regression analysis were performed. A probability value of <.05 was considered statistically significant. RESULTS: Ninety-three @entity1 underwent laparoscopic bilateral uterosacral ligament suspension during study period. Of these, 66 @entity1 had a standardized preoperative pelvic magnetic resonance image per institutional protocol. Thirteen @entity1 (19.6%) met the criteria for @entity177 by 1 year. An optimal cutoff point of 38.5 was calculated by Liu's method for optimization. Among the @entity1 with defined surgical failures, 84.6% (11/13) had an estimated levator ani subtended volume above cutoff point of 38.5. Among the @entity1 with defined surgical success, 39.6% (21/53) had an estimated levator ani subtended volume above the cutoff point (84.6% vs 39.6%; P  = .0048) with a significant odds ratio of 8.38 (95% confidence interval, 1.69-41.68; P  = .009). An area under receiver operating characteristics curve of 0.725 (95% confidence interval, 0.603-0.847), sensitivity of 84.6% (95% confidence interval, 54.6%-98.1%), and specificity of 60.4% (95% confidence interval, 46%-73.5%) at 38.5 were predictors of surgical success/failure by 1 year. Logistic regression analysis demonstrated no significant confounders among age, body mass index, stage, or parity. CONCLUSIONS: Estimated levator ani subtended volume may predict @entity177 for laparoscopic bilateral uterosacral ligament suspension. @entity1 with a calculated estimated levator ani subtended volume above 38.5 on a preoperative pelvic magnetic resonance imaging were associated with an increased risk for @entity177 by 1 year, regardless of age, body mass index, stage, or parity. Future investigation that will include repeatability, reliability analysis, and a prospective study is warranted.
