ABSTRACT (250/250 words, excluding headings):
Objective: To identify postoperative vaginal morphology and
position factors associated with prolapse recurrence following vaginal
surgery.
Design: Secondary analysis of MRIs of the Defining Mechanisms
of Anterior Vaginal Wall Descent cross-sectional study.
Setting: Eight clinical sites in the US Pelvic Floor Disorders
Network.
Population: Women who underwent vaginal mesh hysteropexy
(hysteropexy) with sacrospinous fixation or vaginal hysterectomy with
uterosacral ligament suspension (hysterectomy) for symptomatic
uterovaginal prolapse between April 2013 and February 2015.
Methods: MRIs (rest, strain) obtained 30-42 months after
surgery, or earlier for participants with recurrence who desired
reoperation prior to 30 months, were analyzed. Prolapse recurrence was
defined as prolapse beyond the hymen at strain on MRI. Vaginal
segmentations (at rest) were used to create 3D models placed in a
morphometry algorithm to quantify and compare vaginal morphology
(angulation, dimensions) and position between groups.
Main Outcome Measures: Vaginal angulation (upper, lower, and
upper-lower vaginal angles in the sagittal and coronal plane),
dimensions (length, maximum transverse width, surface area, volume), and
position (apex, mid-vagina) at rest.
Results: Of the 82 women analyzed, 12/41 (29%) in the
hysteropexy group and 22/41 (54%) in the hysterectomy group had
prolapse recurrence. After hysteropexy, recurrences had a more laterally
deviated upper vagina (p=0.02) at rest than successes. After
hysterectomy, recurrences had a more inferiorly (lower) positioned
vaginal apex (p=0.01) and mid-vagina (p=0.01) at rest than successes.
Conclusions: Vaginal angulation and position were associated
with prolapse recurrence and indicative of vaginal support mechanisms
related to surgical technique and unaddressed anatomical defects. Future
prospective studies in women before and after prolapse surgery may
distinguish these two factors.
Funding: Eunice Kennedy Shriver National Institute of Child
Health and Human Development-sponsored Pelvic Floor Disorders Network
(Grant/Award Number: U10 HD054214, U10 HD041267, U10 HD041261, U10
HD069013, U10 HD069025, U10 HD069010, U10 HD069006, U10 HD054215, U01
HD069031); National Institutes of Health Office of Research on Women’s
Health; Boston Scientific Corporation; National Academies of Sciences,
Engineering, and Medicine’s Ford Foundation Predoctoral Fellowship
Program