{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T21:11:31Z","timestamp":1781557891115,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:00:00Z","timestamp":1743292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1\u2009year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligament suspension and perineal repair). The aim of the present study was to compare women with and without levator ani muscle avulsions in terms of patient\u2010reported and anatomical outcomes, and failure rates in the same cohort after 5\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>Five\u2010year prospective cohort study of 143 women operated on for anterior and\/or mid\u2010compartment pelvic organ prolapse with the Manchester procedure between October 2014 and January 2017, Clinical Trial study number NCT02246387. Levator ani muscle avulsions (uni\u2010 or bilateral) were diagnosed at inclusion by transperineal ultrasound. Primary outcome at 5\u2010year follow\u2010up was subjective bulge symptoms (question 3, Pelvic Floor Distress Inventory\u201020). Secondary outcomes were total score from the same questionnaire, sexual distress (Pelvic Organ Prolapse\/Urinary Incontinence Sexual Questionnaire\u201012), subjective cure, Pelvic Organ Prolapse Quantification scale measurements, defining optimal outcomes as anterior compartment stage &lt;0\u20131 and mid\u2010compartment point C \u2264\u22125, and new surgical or conservative prolapse treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 143 women followed up after 5\u2009years, the avulsion rate was 52.4%. Both groups showed similar reductions in bulge symptoms, pelvic floor symptoms, and anatomical anterior\u2010 and mid\u2010compartment measurements. Sexual distress improvement was significantly greater for women with avulsion (Mean change difference: \u22123.4 (\u22126.4 to \u22120.5)). Multivariate regression revealed no significant effect of avulsion on symptom scores, cure rates, or need for new prolapse treatment. Women with avulsion had half the odds of obtaining an optimal anterior compartment outcome compared to those without avulsion (adjusted odds ratio: 0.5 (0.2\u20130.9)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although women with levator ani muscle avulsion had lower odds of achieving an optimal anterior compartment outcome, the overall anatomical changes from preoperative to 5\u2009years were similar in both groups. Importantly, avulsion did not impact symptom improvement, patient\u2010reported outcomes, or the need for further treatment. These findings support the Manchester procedure as an effective and durable surgical option for women with POP, regardless of avulsion status.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15102","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T04:47:40Z","timestamp":1743482860000},"page":"1200-1206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5\u2010year follow\u2010up study"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0766-4523","authenticated-orcid":false,"given":"Sissel Hegdahl","family":"Oversand","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo (UiO)  Oslo 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