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All patients underwent a standardized transperineal ultrasound assessment preoperatively and at 3 months postoperatively. Ballooning was defined as a levator hiatus area (LHA) of \u2265 25 cm\n                      <jats:sup>2<\/jats:sup>\n                      on straining maneuver. A multivariable binary logistic regression model was developed to predict the presence of postoperative ballooning. The model\u2019s performance was assessed using Harrell\u2019s C-index (AUC) and calibration plots.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Although surgery resulted in a significant mean reduction of the LHA on straining (from 29.60 \u00b1 8.30 cm\n                      <jats:sup>2<\/jats:sup>\n                      to 27.17 \u00b1 7.24 cm\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      &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\u20130.999), body mass index (OR 1.095; 95% CI 1.004\u20131.194), and preoperative resting LHA (OR 1.276; 95% CI 1.158\u20131.405). 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\u20130.91) and good calibration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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 \u201cuncorrected defect\u201d using preoperative resting biometry. Identifying this high-risk phenotype is crucial for patient counseling and managing expectations regarding long-term recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-026-06662-z","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:29:44Z","timestamp":1777883384000},"page":"2989-2998","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Uncorrected Defect: A Risk Stratification Model for Persistent Levator Ballooning Following Pelvic Organ Prolapse Repair"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-5583","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Garc\u00eda-Mejido","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Garc\u00eda-Pombo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaya","family":"Salas-\u00c1lvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Fern\u00e1ndez-Palac\u00edn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Bugatto-Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Antonio","family":"Sainz-Bueno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"6662_CR1","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1007\/s00192-015-2695-8","volume":"26","author":"TFM Vergeldt","year":"2015","unstructured":"Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. 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