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] (3rd Quarter 2015 MOC FPM) AKD
Objective: To assess if the severity of levator ani defects (LAD) can predict prolapse.
Secondary analysis of two case-control studies.
LAD were assessed by MRI with scores from 0 (no defects) to 6 (complete, bilateral defects)
Minor defects were a LAD score of 1-3
Major defects were a LAD score of 4-6
The likelihood of prolapse correlates with increasing LAD scores
An LAD score of 3 is the threshold to predict prolapsed
LAD score of 0-2 have rates of prolapsed lower than expected
LAD scores of > 3 have prolapsed higher than expected.
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.