Estimated levator ani subtended volume: a novel assay for predicting surgical failure after uterosacral ligament suspension

Wyman, A.M.; Rodrigues, Antônio Antunes; Hahn, Lindsey; Greene, K.A.; Bassaly, Renee; Hart, Stuart; Miladinović, Branko; Hoyte, Lennox

doi:10.1016/j.ajog.2015.11.005

Cited by 21 publications

(22 citation statements)

References 25 publications

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“…The H line (anteroposterior width of the levator hiatus), M-line (represent distance of its descent) and the width of the levator hiatus were also measured in millimeters in static MRI to calculate the eLASV: eLASV in mm 3 ¼ À72.838 þ 0.598 (H-line) þ 1.217 (M-line) þ 1.136 (width of levator hiatus). 9 The variables of the physical examination were basically defined by POP-Q measurements. 12 Sociodemographic characteristics were also recorded.…”

Section: Discussionmentioning

confidence: 99%

“…7 Rodrigues Junior et al 8 have recently described the estimated levator ani subtended volume (eLASV) through MRI, and have showed significant posterior enlargement in patients with surgical failure following reconstructive prolapse surgery. 8,9 Apical defects (uterine prolapse, vault prolapse) are usually corrected by abdominal sacrocolpopexy (ASC) or vaginal sacrospinous fixation (VSF). In a previous study (Juliato et al 10 ), our group showed that using an anterior mesh (VSF-AM) in the anterior compartment, the vaginal axis is deviated in both surgeries, however with no difference between them.…”

Section: Introductionmentioning

confidence: 99%

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Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial

Santos

Brito

Castro

et al. 2021

Rev Bras Ginecol Obstet

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Objective Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse. Methods In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. Results After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002). Conclusion Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial

Santos

Brito

Castro

et al. 2021

Rev Bras Ginecol Obstet

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“…Prior research on the levator subtended volume measured on MRI has used resting scans; therefore, our data using straining measurements extends this by providing an evaluation of changes in the pelvic floor at maximal Valsalva. 8–10 These assessments that quantify the consequences of levator ani muscle impairment add an additional element to what has traditionally been seen on clinical examination. This may add to our understanding of surgical failure.…”

Section: Commentmentioning

confidence: 99%

“…This may add to our understanding of surgical failure. 10 This is not to suggest that POP-Q be abandoned, but rather that we develop techniques to assess what goes on above the hiatus for research assessment of pelvic organ prolapse. As descent of the pelvic floor, may be a predictor of prolapse, developing a simple way of assessing it would have clinical benefit.…”

Section: Commentmentioning

confidence: 99%

Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse

Sammarco

Nandikanti

Kobernik

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Pelvic organ prolapse has two components; 1) protrusion of the pelvic organs beyond the hymen and 2) descent of the levator ani. The Pelvic Organ Prolapse Quantification system measures the first component, however, there remains no standard measurement protocol for the second mechanism. Objectives Test the hypotheses that 1) difference in the protrusion area is greater than the area created by levator descent in prolapse patients compared with controls and, 2) Prolapse is more strongly associated with levator hiatus compared to urogenital hiatus. Study Design Mid-sagittal MRI scans from 30 controls, 30 anterior predominant and 30 posterior predominant prolapse patients were assessed. Levator area was defined as the area above the levator ani and below the sacrococcygeal inferior pubic point line. Protrusion area was defined as the protruding vaginal walls below the levator area. The levator hiatus and urogenital hiatus were measured. Bivariate analysis and multiple comparisons were performed. Bivariate logistic regression was performed to assess prolapse as a function of levator hiatus, urogenital hiatus, levator area, and protrusion. Pearson correlation coefficients were calculated. Results The levator area for the anterior (34.0±6.5cm2) and posterior (35.7±8.0cm2) prolapse groups were larger during Valsalva compared to controls (20.9±7.8cm2, p<.0001 for both); similarly, protrusion areas for the anterior (14.3±6.2cm2) and posterior (14.4±5.7cm2) were both larger than controls (5.0±1.8cm2, p<.0001 for both). The levator hiatus length for the anterior (7.2±1cm) and posterior (6.9±1cm) were longer during Valsalva compared to controls (5.2±1.5cm, p<.0001 for both); similarly, urogenital hiatus lengths for the anterior (5.7±1cm) and posterior (6.3±1.1cm) were both longer than controls (3.8±0.8cm, p<.0001 for both). The difference in levator area in prolapse patients compared with controls was greater than the difference in protrusion area (14.0 ± 7.2cm2 v. 9.4 ± 5.9cm2, p<.0002). The urogenital was more strongly associated with prolapse than the levator hiatus (OR: 12.9, 95% CI: (4.1–39.2), OR: 4.3, 95% CI: (2.3–7.5)). Levator hiatus and urogenital hiatus are both correlated with levator and protrusion areas, and all were associated with maximum prolapse size (p≤0.001, for all comparisons). Conclusions In prolapse, the levator area increases more than the protrusion area and both the urogenital hiatus and levator hiatus are larger. The odds of prolapse for an increase in the urogenital hiatus are three times larger than for the levator hiatus, which leads us to reject both the original hypotheses.

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“…Laparoscopic high uterosacral ligament suspension (L-HUSLS) is an alternative surgical intervention for apical prolapse correction using native tissue with feasibility, safety, and efficacy already demonstrated by several studies (13)(14)(15)(16)(17)(18). When compared with the conventional vaginal approach, the laparoscopic procedure has similar objective success rates and a small number of ureteral injuries (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic High Uterosacral Ligament Suspension vs. Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse: A Case-Control Study

et al. 2022

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IntroductionLaparoscopic sacral colpopexy is the gold standard technique for apical prolapse correction but it is a technically challenging procedure with rare but severe morbidity. Laparoscopic high uterosacral ligament suspension could be a valid technically easier alternative using native tissue.Material and MethodsIn the period from 2015 to 2018, 600 women were submitted to laparoscopic sacral colpopexy while 150 to laparoscopic high uterosacral ligament suspension in three Italian urogynecology referral centers. We enrolled women with apical prolapse stage ≥2 alone or multicompartment descensus. To reduce allocation bias, we performed a propensity matched analysis. Women undergoing laparoscopic high uterosacral ligament suspension surgery were matched 1:2 to women undergoing laparoscopic sacral colpopexy. The cumulative proportion of relapse-free women in time was analyzed by the Kaplan–Meier method. The primary objective of this multicenter case-control retrospective study was to compare the recurrence rate while the secondary objectives were to compare feasibility, safety, and efficacy of laparoscopic sacral colpopexy and laparoscopic high uterosacral ligament suspension in surgical treatment of pelvic organ prolapse.ResultsThree hundred and nine women were enrolled (103 laparoscopic high uterosacral ligament suspension; 206 laparoscopic sacral colpopexy). Median operatory time was significantly shorter in the laparoscopic high uterosacral ligament suspension group (P = 0.0001). No statistically significative difference was found in terms of estimated blood loss, admission time, intraoperative, and major early postoperative complications, postoperative pelvic pain, dyspareunia and de novo stress urinary incontinence. Surgical approach was the only independent risk factor for prolapse recurrence (RR = 6.013 [2.965–12.193], P = 0.0001). The objective cure rate was higher in the laparoscopic sacral colpopexy group (93.7 vs. 68%, 193/206 vs. 70/103, P = 0.0001) with a highly reduced risk of recurrence (RR = 5.430 [1.660–17.765]). Median follow up was 22 months.ConclusionBoth techniques are safe, feasible, and effective. Laparoscopic sacral colpopexy remains the best choice in treatment of multicompartment and advanced pelvic organ prolapse while laparoscopic high uterosacral ligament suspension could be appropriate for moderate and isolated apical prolapse when laparoscopic sacral colpopexy is not suitable for the patient or to prevent prolapse in women at high risk at the time of the hysterectomy.

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Estimated levator ani subtended volume: a novel assay for predicting surgical failure after uterosacral ligament suspension

Cited by 21 publications

References 25 publications

Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial

Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial

Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse

Laparoscopic High Uterosacral Ligament Suspension vs. Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse: A Case-Control Study

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