Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair surgery

Purpose: To estimate whether levator ani injuries increase the risk of de novo urinary stress incontinence after cystocele repairing surgery. Methods: A total of 1124 women who were underwent cystocele repaired surgeries were recruited and assessed for eligibility from January,1,2012 to April,30,2021. All data related to patients and surgeries was collected and followed-up, which included general conditions, clinical examination, ultrasound results and follow-up results. Data was compared according to the follow up results. The relative risk (RR) of de novo urinary stress incontinence (SUI) with levator avulsion was calculated. Results: 336 women were involved eventually. They were divided into no complication group (n=249), de novo SUI group (n=68) and other complications group (n=19). It seemed elder or obese women were more likely to get poor results after TVM repair (p＜0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups(p=0.001). TVM can significantly change a prolapse to point Aa and Ba on POP-Q (p＜0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95%CI 1.39-4.87), and 2.58(95%CI 0.82 -8.15) for bilateral group. Conclusion: Unilateral levator avulsion is a risk factor of de novo SUI after cystocele repair surgery.