Defining mechanisms of recurrence following apical prolapse repair based on imaging criteria

Bowen, Shaniel T.; Moalli, Pamela; Abramowitch, Steven D.; Lockhart, Mark E.; Weidner, Alison C.; Richter, Holly E.; Rardin, Charles R.; Komesu, Yuko M.; Harvie, Heidi S.; Mazloomdoost, Donna; Sridhar, Amaanti; Gantz, Marie G.; Albo, Michael; Alperin, Marianna; Columbo, Joann; Curry, Jodi; Ferrante, Kimberly L.; Herrala, Kyle; Johnson, Sherella; Kirby, Anna C.; Lukacz, Emily S.; Nager, Charles W.; Ruppert, Erika; Wasenda, Erika; Diwadkar, Gouri B.; Dyer, Keisha Y.; Mackinnon, Linda M.; Menefee, Shawn A.; Tan-Kim, Jasmine; Zazueta-Damian, Gisselle; Amundsen, Cindy L.; Bruton, Yasmeen; Coleman-Taylor, Notorious; Gilliam, Robin; Harris, A.; Hayes, Akira; Kawasaki, Amie; Longoria, Nicole; McLean, Shantae; Raynor, Mary; Siddiqui, Nazema Y.; Visco, Anthony G.; Ballard, Alicia; Ellington, David R.; Patel, Sunita K.; Saxon, Nancy; Varner, R. Edward; Willis, V. N. B.; Carter, Kathy; Carberry, Cassandra; Douglas, Samantha B.; Hampton, Brittany Star; Korbly, Nicole B.; Meers, Ann S.; Myers, Deborah L.; Sung, Vivian W.; Viscione, Elizabeth-Ann; Wohlrab, Kyle; Box, Karen; Dunivan, Gena C.; Jeppson, Peter C.; Middendorf, Julia; Rogers, Rebecca G.; Arya, Lily A.; Andy, Uduak U.; Butler, Norman; Cain, Doris; Carney, Teresa; Flick, Lorraine; Khanijow, K.D.; Kingslee, Michelle; Lee, Daniel; O’Donnell, Patricia; Smith, Ariana L.; Thompson, D.; Bonidie, Michael; Gruss, Judy; Lowder, Jerry L.; Shepherd, Jonathan; Sutkin, Gary; Zyczynski, Halina M.; Barber, Matthew D.; Dastoli, Kathleen; Edington, Maryori; Graham, Annette; Krishnan, Geetha; Jelovsek, Eric; Paraíso, Marie Fidela R.; Pung, Ly; Ferrando, Cecile A.; Walters, Mark D.; Meikle, Susan; Burd, Andrew; Burdekin, Kate; Glass, Kendra; Grant, Tracey; Grey, Scott F.; Ham, Michael; Pickett, James D.; Wallace, Dennis; Whitworth, Ryan; Shaffer, Amanda; Swankie, Taylor

doi:10.1016/j.ajog.2021.05.041

Cited by 9 publications

(14 citation statements)

References 24 publications

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“…This was a secondary analysis of MRI data from the DEMAND study, a multisite prospective supplementary study of the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial, designed to identify anatomic mechanisms and correlates of prolapse recurrence among a subset of SUPeR participants randomised to either (1) vaginal mesh hysteropexy with sacrospinous fixation (hysteropexy) with the Uphold LITE transvaginal mesh support system (Boston Scientific, Marlborough, MA, USA) or (2) vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) performed bilaterally with one delayed absorbable and one permanent suture on each side. 10,11 DEMAND and SUPeR were performed through the Pelvic Floor Disorders Network. Detailed study protocol and 3-year outcomes for both studies have been published.…”

Section: Methodsmentioning

confidence: 99%

“…Detailed study protocol and 3-year outcomes for both studies have been published. [10][11][12][13] Institutional review board approval and participants' written informed consent were obtained at all study sites. Participants and the public…”

Section: Methodsmentioning

confidence: 99%

“…Vaginal mobility/distensibility and GH size measurements were obtained from the primary DEMAND study by previously described methods. 10 In short, rest and strain sagittal MRI were co-registered in 3D Slicer using the 3D PCS. In the midsagittal plane, the anterior and posterior vaginal walls were outlined.…”

Section: Vaginal Mobility/distensibility and Genital Hiatus Measuresmentioning

confidence: 99%

“…Results suggested that these mechanisms may involve postoperative changes in vaginal angulation and position (i.e., straightening and posterior-inferior deviation) that promote vaginal mobility/distensibility by making the AVW more susceptible to descent and elongationespecially with an enlarged genital hiatus (GH). 10 The primary DEMAND study and similar works were limited to two-dimensional (2D) vaginal analysis. Therefore, this study evaluated the relationship between vaginal anatomy and prolapse recurrence after vaginal surgery using 3D vaginal analysis.…”

Section: Introductionmentioning

confidence: 99%

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Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Bowen

Moalli

Abramowitch

et al. 2023

BJOG

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ObjectiveTo identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.DesignSecondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross‐sectional study.SettingEight clinical sites in the US Pelvic Floor Disorders Network.Population or SampleWomen 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.MethodsThe 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.Main outcome measuresVaginal 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.ResultsOf 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.ConclusionsVaginal 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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Vaginal Mobility/distensibility and Genital Hiatus Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Bowen

Moalli

Abramowitch

et al. 2023

BJOG

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“…5 There are different types of POP recurrences, 6,7 and different surgical techniques have been recommended to avoid such events. 8 There are multiple risk factors that influence the recurrence of POP, 9,10 with the main Video online at jultrasoundmed.org Supplemental material online at jultrasoundmed.org mechanism being the descent of apical support after vaginal hysterectomy, 11,12 in addition to its association with urinary incontinence. 13,14 Therefore, a correct diagnosis before surgery is crucial for the correct treatment of patients.…”

mentioning

confidence: 99%

Is It Possible to Diagnose Surgical Uterine Prolapse With Transperineal Ultrasound? Multicenter Validation of Diagnostic Software

García‐Mejido

Martín‐Martinez²,

González-Díaz³

et al. 2023

J of Ultrasound Medicine

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ObjectivesTo validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP).MethodsMulticenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II–IV UP. Transperineal ultrasound was used to assess the difference in the pubis–uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed.ResultsA total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84–0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%).ConclusionsWe validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations.

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Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse

Miller

Wolfe

Gentry

et al. 2023

Adv Healthcare Materials

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Uterosacral ligament suspension (USLS) is a common surgical treatment for pelvic organ prolapse (POP). However, the relatively high failure rate of up to 40% underscores a strong clinical need for complementary treatment strategies, such as biomaterial augmentation. Herein, the first hydrogel biomaterial augmentation of USLS in a recently established rat model is described using an injectable fibrous hydrogel composite. Supramolecularly‐assembled hyaluronic acid (HA) hydrogel nanofibers encapsulated in a matrix metalloproteinase (MMP)‐degradable HA hydrogel create an injectable scaffold showing excellent biocompatibility and hemocompatibility. The hydrogel can be successfully delivered and localized to the suture sites of the USLS procedure, where it gradually degrades over six weeks. In situ mechanical testing 24 weeks post‐operative in the multiparous USLS rat model shows the ultimate load (load at failure) to be 1.70 ± 0.36 N for the intact uterosacral ligament (USL), 0.89 ± 0.28 N for the USLS repair, and 1.37 ± 0.31 N for the USLS + hydrogel (USLS+H) repair (n = 8). These results indicate that the hydrogel composite significantly improves load required for tissue failure compared to the standard USLS, even after the hydrogel degrades, and that this hydrogel‐based approach can potentially reduce the high failure rate associated with USLS procedures.

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Defining mechanisms of recurrence following apical prolapse repair based on imaging criteria

Cited by 9 publications

References 24 publications

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Is It Possible to Diagnose Surgical Uterine Prolapse With Transperineal Ultrasound? Multicenter Validation of Diagnostic Software

Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse

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