Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study.
MRI
angulation
dimension
hysterectomy
hysteropexy
pelvic organ prolapse
position
prolapse recurrence
vagina
vaginal mesh
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Feb 2024
Feb 2024
Historique:
revised:
10
06
2023
received:
16
01
2023
accepted:
11
07
2023
pmc-release:
01
02
2025
medline:
15
1
2024
pubmed:
31
7
2023
entrez:
31
7
2023
Statut:
ppublish
Résumé
To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. Eight clinical sites in the US Pelvic Floor Disorders Network. Women who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015. The MRI (rest, strain) obtained 30-42 months after surgery, or earlier for participants with recurrence who desired reoperation before 30 months, were analysed. MRI-based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three-dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position. 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. Of the 82 women analysed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (p = 0.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (p = 0.01) and mid-vagina (p = 0.01) at rest than women with successful surgery. Vaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.
Identifiants
pubmed: 37522240
doi: 10.1111/1471-0528.17620
pmc: PMC10828105
mid: NIHMS1918068
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
267-277Subventions
Organisme : NICHD NIH HHS
ID : U10 HD041261
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD069013
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD054215
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD054214
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD069006
Pays : United States
Organisme : NICHD NIH HHS
ID : U01 HD069031
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD041267
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD069025
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD069010
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD069013
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD054214
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD069006
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD069010
Pays : United States
Investigateurs
Kimberly Ferrante
(K)
Sherella Johnson
(S)
Emily S Lukacz
(ES)
Charles W Nager
(CW)
Gouri B Diwadkar
(GB)
Keisha Y Dyer
(KY)
Linda M Mackinnon
(LM)
Jasmine Tan-Kim
(J)
Gisselle Zazueta-Damian
(G)
Cindy Amundsen
(C)
Yasmeen Bruton
(Y)
Notorious Coleman-Taylor
(N)
Amie Kawasaki
(A)
Shantae McLean
(S)
Nazema Siddiqui
(N)
Alison Weidner
(A)
Kathy Carter
(K)
David Ellington
(D)
Mark E Lockhart
(ME)
Sunita Patel
(S)
Holly E Richter
(HE)
Nancy Saxon
(N)
Velria B Willis
(VB)
Cassandra Carberry
(C)
B Star Hampton
(BS)
Nicole Korbly
(N)
Ann S Meers
(AS)
Deborah L Myers
(DL)
Vivian W Sung
(VW)
Elizabeth-Ann Viscione
(EA)
Kyle Wohlrab
(K)
Gena Dunivan
(G)
Yuko Komesu
(Y)
Peter Jeppson
(P)
Lily Arya
(L)
Lorraine Flick
(L)
Michelle Kingslee
(M)
Ariana Smith
(A)
Michael Bonidie
(M)
Judy Gruss
(J)
Jonathan Shepherd
(J)
Gary Sutkin
(G)
Halina M Zyczynski
(HM)
Matthew Barber
(M)
Annette Graham
(A)
Marie Fidela R Paraiso
(MFR)
Cecile Ferrando
(C)
Rebecca G Rogers
(RG)
Kate Burdekin
(K)
Michael Ham
(M)
Amaanti Sridhar
(A)
Dennis Wallace
(D)
Ryan Whitworth
(R)
Taylor Swankie
(T)
Informations de copyright
© 2023 John Wiley & Sons Ltd.
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