Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation—a randomized trial

Juliato, Cássia Raquel Teatin; Santos‐Junior, Luiz Carlos; Castro, Edilson Benedito de; Dertkigil, Sérgio; Brito, Luiz Gustavo Oliveira

doi:10.1002/nau.23970

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…Postmortem muscle fixation and rectal dilatation cause forward movement and shortening of the vagina in cadavers, resulting in a large error between pre- and postmortem evaluations. The boundaries of the uterus and vagina are visible in sagittal MR images; therefore, the positions and axes of the uterus and vagina can be measured and quantified using MRI without distortion ( 3 ). MRI is useful to study the pelvic organs and the functional anatomy of the pelvic floor in living women.…”

Section: Discussionmentioning

confidence: 99%

“…Fifty percent of parturient women experience POP-related symptoms, and 30–50% of adult women are affected by POP, including 11–19% who require surgery ( 1 , 2 ). The reoperation rate is as high as 30% ( 3 ). Although POP is closely related to damage of the uterine and vaginal supporting structures and uterine and vaginal morphological changes, the pathogenesis of POP is unclear ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Axes and Positions of the Uterus and Vagina Between Women With and Without Pelvic Floor Organ Prolapse

Wen

Gao

et al. 2022

Front. Surg.

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PurposeTo analyze the role of the axial positions of the uterus and vagina in providing pelvic floor support, encourage evaluations of pelvic floor function, and improve the understanding of the pathogenesis of pelvic organ prolapse.MethodsThe lengths and angles of the upper, middle, and lower axes of the vagina, uterine body, and cervix of 81 women with prolapse (prolapse group) and 57 women without prolapse (non-prolapse group) were measured and compared using magnetic resonance images. The pelvic inclination correction system (PICS) line was also compared between the groups. The coordinate parameters of the anatomical points of the uterus and vagina were measured, and their positions were analyzed.ResultsIn the prolapse group, the uterine body-cervical angle, cervical-upper vaginal angle, uterine body-PICS line angle, cervical-PICS line angle, and lower vaginal-PICS line angle were smaller (p < 0.05) and the middle-lower vaginal angle, upper vaginal-PICS line angle, and middle vaginal-PICS line angles were larger (p < 0.05) than those in the non-prolapse group. The cervical length was longer (p < 0.05) and the middle and lower vaginal lengths were shorter (p < 0.05) in the prolapse group. The coordinate system revealed that the uterine and vaginal axes were shifted backward and downward in the prolapse group.ConclusionPatients in the prolapse group were more likely to have retroversion and retroflexion of the uterus than those in the non-prolapse group. The vagina was shortened, turned forward, and straightened, and the uterus and vagina were shifted backward and downward in the prolapse group. Changes in the axial position of the uterus and vagina are important mechanisms of pelvic floor organ prolapse.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Axes and Positions of the Uterus and Vagina Between Women With and Without Pelvic Floor Organ Prolapse

Wen

Gao

et al. 2022

Front. Surg.

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“…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. 10 Nonetheless, we still have little data about the behavior of the MRI lines of reference for patients operated for POP and their association with physical examination findings and subjective cure using standardized questionnaires.…”

Section: Introductionmentioning

confidence: 72%

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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“…Magnetic resonance imaging (MRI) has been used to assess vaginal anatomy following POP repair. [3][4][5][6][7][8][9] However, little is known about how vaginal morphology and position relate to prolapse recurrence after POP surgery. In our previous work, the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study, we showed that apical descent and-to a lesser extent-anterior vaginal wall (AVW) elongation were mechanisms of prolapse recurrence following vaginal surgery.…”

Section: Introductionmentioning

confidence: 99%

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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Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation—a randomized trial

Cited by 14 publications

References 36 publications

Comparison of the Axes and Positions of the Uterus and Vagina Between Women With and Without Pelvic Floor Organ Prolapse

Comparison of the Axes and Positions of the Uterus and Vagina Between Women With and Without Pelvic Floor Organ Prolapse

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

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

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