The Uncorrected Defect: A Risk Stratification Model for Persistent Levator Ballooning Following Pelvic Organ Prolapse Repair

OBJECTIVE: To develop and validate a multivariable prediction model capable of identifying patients at high risk of persistent levator hiatus ballooning 3 months following primary POP reconstructive surgery. METHOD: on straining maneuver. A multivariable binary logistic regression model was developed to predict the presence of postoperative ballooning. The model's performance was assessed using Harrell's C-index (AUC) and calibration plots. RESULTS: ; p < 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 0.920-0.999), body mass index (OR 1.095; 95% CI 1.004-1.194), and preoperative resting LHA (OR 1.276; 95% CI 1.158-1.405). 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 0.77-0.91) and good calibration. CONCLUSIONS: 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 "uncorrected defect" using preoperative resting biometry. Identifying this high-risk phenotype is crucial for patient counseling and managing expectations regarding long-term recurrence.