The risk factors of anatomical cystocele recurrence: the hiatal area and the lowest vaginal mesh location observed by pelvic floor ultrasound.

Abstract

<h4>Objectives</h4>To explore the risk factors for the anatomical cystocele recurrence (ACR) after transvaginal mesh (TVM) implantation.<h4>Methods</h4>Patients with a TVM between 2015 and 2023 were enrolled. ACR is determined as the bladder descended ≥ 10 mm below the pubic symphysis or a cystocele stage II or higher. The lowest mesh position (LMP) determined by ultrasound corresponded to the caudal mesh end relative to the bladder neck at maximum descent. Positions below the bladder neck were noted as negative values. The hiatal area (HA) was measured using four-dimensional pelvic floor ultrasound. The differences between women with ACR and without were analyzed.<h4>Results</h4>We enrolled 111 women with a median follow-up of 13 months. Group I included 25 (22.5%) women with ACR. Group II had 86 controls. The median LMP was - 7.0 mm (range - 23 to 18). It was higher in Group I than in Group II (- 3.0 mm vs. - 7.0 mm; p = 0.005). In predicting ACR, LMP had an odds ratio of 1.08 (p = 0.015) and a cutoff of - 3.0 mm (52.3% sensitivity and 72.0% specificity). Multivariate regression analysis revealed odds ratios of 4.3, 3.2, 10.7, and 5.0 (all p < 0.05) for preoperative cystocele stage IV, preoperative HA ≥ 30 cm², postoperative HA ≥ 29 cm², and LMP ≥ -3 mm, respectively.<h4>Conclusions</h4>The larger the HA, the higher the risk of postoperative cystocele. If the caudal mesh end is located more than 3 mm below the bladder neck, the risk of ACR is 500%.