FPMRS AMOC Manual sample

Article:

Levator ani defect scores and pelvic organ prolapse: Is there a threshold effect? Berger MB, Morgan DM, DeLancey JO. (Aug) Int Urogynecol J. 2014(Oct);25(10):1375-9 [PMID: 24788366] (3^rd Quarter 2015 MOC FPM) AKD

1. Objective: To assess if the severity of levator ani defects (LAD) can predict prolapse.

1. Methods:
2. Secondary analysis of two case-control studies.
3. LAD were assessed by MRI with scores from 0 (no defects) to 6 (complete, bilateral defects)
   1. Minor defects were a LAD score of 1-3
   2. Major defects were a LAD score of 4-6

1. Results
   1. The likelihood of prolapse correlates with increasing LAD scores
   2. An LAD score of 3 is the threshold to predict prolapsed
      1. LAD score of 0-2 have rates of prolapsed lower than expected
      2. LAD scores of > 3 have prolapsed higher than expected.
   3. LAD scores alone explain prolapse in only 70% of women. Other factors such as tissue strength and composition, genetics, non-levator changes and medical co-morbidities are variables as well.