CLINICAL ARTICLE Wide genital hiatus is a risk factor for recurrence following anterior vaginal repair Carlos A. Medina a, ⁎ , Keith Candiotti b , Peter Takacs a a Department of Obstetrics and Gynecology, University of Miami, Miller School of Medicine, Miami, FL, USA b Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL, USA Received 11 October 2007; received in revised form 8 November 2007; accepted 8 November 2007 Abstract Objective: To determine if a wide genital hiatus is a risk factor for recurrence of anterior vaginal wall prolapse following anterior vaginal repair. Methods: A retrospective cohort study was performed on patients who had undergone an anterior vaginal wall repair. Patients were placed into 1 of 2 groups: wide genital hiatus (≥ 5 cm) or normal genital hiatus (b 5 cm). The wide genital hiatus group (n = 35) was compared with the normal genital hiatus group (n = 30) for surgical failure. Results: There were no significant differences between the 2 groups in demographic data, additional operative procedures, or apical suspensions. The rate of postoperative anterior vaginal wall prolapse was greater in patients with a wide genital hiatus compared with those with a normal genital hiatus (34.3% vs 10% respectively; odds ratio 4.7 [95% confidence interval, 1.0– 24.1]; P = 0.02). Conclusion: The rate of recurrent anterior vaginal wall prolapse is higher in patients with a wide genital hiatus. © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. KEYWORDS Anterior vaginal wall; Genital hiatus; Prolapse; Recurrence 1. Introduction One of the most difficult challenges facing the pelvic reconstructive surgeon is the management of anterior vaginal wall prolapse. A recurrence of prolapse in the anterior vaginal wall can occur in 20% to 40% of patients undergoing anterior colporrhaphy [1–3]. This high recur- rence rate has provoked considerable attention to the pathophysiology and types of repairs for prolapse. Among the many factors contributing to anterior vaginal wall prolapse, pelvic floor musculature has been found to play an important role. An enlarged genital hiatus has previously been shown to correlate with severity and recurrence of pelvic organ prolapse (POP) following repair [4–6]. Berglas and Rubin [7] investigated levator ani function and showed that lengthening of the levator hiatus resulted in a steeper inclination of the levator plate, which was found to be associated with a higher rate of POP. It has been speculated that relaxation of the genital hiatus produces a feeling of a lack of support whenever there is uterine prolapse. Integrity of the genital hiatus contributes to the longevity of support of both the apical and anterior vaginal wall following repair [8,9]. Both Phaneuf [10] and Inmon [11] advocated closure of the vaginal outlet at the ⁎ Corresponding author. Department of Obstetrics and Gynecology (D-50), University of Miami, Miller School of Medicine, Jackson Memorial Hospital, P.O. Box 016960, Miami, FL 33010, USA. Fax: +1 305 325 1469. E-mail address: cmedina@med.miami.edu (C.A. Medina). 0020-7292/$ - see front matter © 2007 International Federation of Gynecology and Obstetrics Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2007.11.008 available at www.sciencedirect.com www.elsevier.com/locate/ijgo International Journal of Gynecology and Obstetrics (2008) 101, 184–187