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Aust N Z J Obstet Gynaecol. 2014 Jun;54(3):206-11. doi: 10.1111/ajo.12171. Epub 2014 Feb 18.

The use of 3-dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery.

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Sydney Medical School Nepean, Penrith, New South Wales, Australia.



Female pelvic organ prolapse is a common condition. Prolapse recurrence following surgical treatment is a significant clinical issue. The aim of this study was to determine risk factors for recurrence, attempting to improve clinical practice by allowing better patient selection prior to surgery.


This was a retrospective study utilising patient records and ultrasound volume imaging data sets obtained in four clinical audits following anterior colporrhaphy ± mesh. Prolapse recurrence was diagnosed clinically and by ultrasound; findings were analysed against potential predictors.


Symptomatic prolapse recurrence was demonstrated in 86 (26%), on clinical examination in 141 (42%) and on ultrasound in 113/334 women (34%). None of the tested predictors were predictive of recurrent symptoms, likely due to a lack of power. However, both levator avulsion and hiatal area on Valsalva were shown to be highly significant predictors of objective prolapse recurrence on clinical examination and ultrasound.


Prolapse recurrence following surgery is a common complaint. The state of the patient's pelvic floor muscle seems to be the strongest determinant.


4D-ultrasound; Hiatal ballooning; levator avulsion; pelvic floor muscle; pelvic organ prolapse

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