Levator ani muscle assessment and its correlation with recurrence of pelvic organ prolapse: a pelvic floor MRI study

PURPOSE: The levator ani muscle (LAM) plays a vital role in pelvic floor support. Understanding its influence on pelvic organ prolapse (POP) recurrence is essential for improving surgical techniques and postoperative care. This study hypothesized that patients with impaired preoperative LAM integrity, as assessed by pelvic floor MRI, had a higher risk of POP recurrence after pelvic floor repair surgery. METHODS: This retrospective study enrolled 38 patients with POP who underwent pelvic floor repair surgery. The patients were categorized into recurrence and non-recurrence groups based on gynecological examinations and Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20) scores. The structural and functional characteristics of the LAM were evaluated using preoperative static and dynamic MRI. A comparative analysis was performed between the two groups, and the Spearman correlation coefficient was used to quantitatively assess the correlation between LAM measurements and postoperative symptoms. RESULTS: The comparative analysis showed that the recurrence group had significantly more LAM injury, thinner puborectalis and iliococcygeus muscles, longer H-lines and M-lines, and larger levator hiatus compared to the non-recurrence group (p<0.05). Furthermore, significant correlations were found between LAM thickness and injury and PFDI-20 scores, with thinner and more severely injured LAM associated with more severe postoperative symptoms (p<0.05). CONCLUSIONS: Incorporating pelvic floor MRI assessment of LAM into preoperative evaluation might help identify patients at higher risk for POP recurrence, allowing for optimized patient management and care. (c) 2025 The Royal College of Radiologists. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.