Publication Date
9-1-2023
Journal
International Urogynecology Journal
DOI
10.1007/s00192-023-05505-5
PMID
36971829
PMCID
PMC10566251
PubMedCentral® Posted Date
9-1-2024
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
Female, Humans, Pelvic Floor, Pelvic Organ Prolapse, Magnetic Resonance Imaging, Ultrasonography, Pelvic organ prolapse, aging, MRI, structural failure, genital hiatus, levator plate
Abstract
INTRODUCTION AND HYPOTHESIS: We sought to 1) test the hypothesis that young women (≤45 years) with pelvic organ prolapse have a higher prevalence of major levator ani muscle (LAM) defects than old women (≥70 years) with prolapse and 2) compare level II/III measurements between young and old women with prolapse and age-matched controls to evaluate age-related mechanistic differences in the disease process.
METHODS: A secondary analysis examined four groups of parous women: young prolapse (YPOP, n = 17); old prolapse (OPOP, n = 17); young controls (YC, n = 15); old controls, (OC, n = 13). Prolapse was defined as any compartment at or beyond the hymen with vaginal bulge symptoms. Genital hiatus (GH) was measured on clinical exam. Major LAM defects and level II/III measurements (UGH: urogenital hiatus, LA: levator area, and apex location) were assessed on MRI at rest and strain, and the difference (Δ) between measurements calculated. Principal component analysis was used to evaluate levator plate (LP) shape.
RESULTS: Major LAM defects occurred in 42% of YPOP and 47% of OPOP (p>.99). GHrest was 1.5 cm larger in OPOP versus YPOP (p<.001) and 2 cm larger in OPOP versus OC (p<.001). Regardless of prolapse status, LArest and UGHrest on MRI increased with age. YPOP had larger ΔLA (p=.04), ΔUGH (p=.03), and Δapex than OPOP (p=.01). Resting LP shape was more dorsally oriented in OPOP versus YPOP (p=.02) and OC versus YC (p=.004).
CONCLUSIONS: Prolapse in young women cannot be solely explained by a higher LAM defect prevalence. GH size and other measures of level II/III pelvic support worsen with age regardless of prolapse status.