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Objective <p>To develop and validate a multivariable prediction model capable of identifying patients at high risk of persistent levator hiatus ballooning 3 months following primary POP reconstructive surgery.</p> Method <p>A prospective observational study was conducted on a consecutive cohort of 140 women undergoing primary surgery for symptomatic POP (POP-Q stage ≥ 2). All patients underwent a standardized transperineal ultrasound assessment preoperatively and at 3 months postoperatively. Ballooning was defined as a levator hiatus area (LHA) of ≥ 25 cm<sup>2</sup> on straining maneuver. A multivariable binary logistic regression model was developed to predict the presence of postoperative ballooning. The model’s performance was assessed using Harrell’s C-index (AUC) and calibration plots.</p> Results <p>Although surgery resulted in a significant mean reduction of the LHA on straining (from 29.60 ± 8.30 cm<sup>2</sup> to 27.17 ± 7.24 cm<sup>2</sup>; <i>p</i> &lt; 0.001), the ballooning phenotype persisted in 57.1% (80/140) of the cohort. The final multivariable model identified three independent predictors: age (OR 0.959; 95% CI 0.920–0.999), body mass index (OR 1.095; 95% CI 1.004–1.194), and preoperative resting LHA (OR 1.276; 95% CI 1.158–1.405). Notably, resting area proved to be a stronger predictor than straining area. The model demonstrated high discriminative ability with an AUC of 0.84 (95% CI 0.77–0.91) and good calibration.</p> Conclusions <p>Surgical correction of POP reduces hiatal dimensions but fails to correct levator ballooning in the majority of patients. We developed a highly accurate predictive model that identifies this “uncorrected defect” using preoperative resting biometry. Identifying this high-risk phenotype is crucial for patient counseling and managing expectations regarding long-term recurrence.</p>

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The Uncorrected Defect: A Risk Stratification Model for Persistent Levator Ballooning Following Pelvic Organ Prolapse Repair

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月4日

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  • José Antonio García-Mejido,
  • Sara García-Pombo,
  • Olaya Salas-Álvarez,
  • Ana Fernández-Palacín,
  • Fernando Bugatto-Gonzalez,
  • José Antonio Sainz-Bueno

摘要

Objective

To develop and validate a multivariable prediction model capable of identifying patients at high risk of persistent levator hiatus ballooning 3 months following primary POP reconstructive surgery.

Method

A prospective observational study was conducted on a consecutive cohort of 140 women undergoing primary surgery for symptomatic POP (POP-Q stage ≥ 2). All patients underwent a standardized transperineal ultrasound assessment preoperatively and at 3 months postoperatively. Ballooning was defined as a levator hiatus area (LHA) of ≥ 25 cm2 on straining maneuver. A multivariable binary logistic regression model was developed to predict the presence of postoperative ballooning. The model’s performance was assessed using Harrell’s C-index (AUC) and calibration plots.

Results

Although surgery resulted in a significant mean reduction of the LHA on straining (from 29.60 ± 8.30 cm2 to 27.17 ± 7.24 cm2; p < 0.001), the ballooning phenotype persisted in 57.1% (80/140) of the cohort. The final multivariable model identified three independent predictors: age (OR 0.959; 95% CI 0.920–0.999), body mass index (OR 1.095; 95% CI 1.004–1.194), and preoperative resting LHA (OR 1.276; 95% CI 1.158–1.405). Notably, resting area proved to be a stronger predictor than straining area. The model demonstrated high discriminative ability with an AUC of 0.84 (95% CI 0.77–0.91) and good calibration.

Conclusions

Surgical correction of POP reduces hiatal dimensions but fails to correct levator ballooning in the majority of patients. We developed a highly accurate predictive model that identifies this “uncorrected defect” using preoperative resting biometry. Identifying this high-risk phenotype is crucial for patient counseling and managing expectations regarding long-term recurrence.