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International Urogynecology Journal
Published in: International Urogynecology Journal 6/2021

01-06-2021 | Magnetic Resonance Imaging | Original Article

Dynamic magnetic resonance imaging following native tissue vaginal reconstructive surgery; a prospective study

Authors: Abigail Shatkin-Margolis, Eugene Duke, Vivian Ghodsi, Austin Hill, Catrina C. Crisp, Rachel N. Pauls

Published in: International Urogynecology Journal | Issue 6/2021

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Abstract

Introduction and hypothesis

To describe the impact of native tissue vaginal reconstruction on pelvic anatomy using dynamic magnetic resonance imaging.

Methods

This prospective single-cohort observational study involved women undergoing native tissue reconstruction with intraperitoneal vaginal vault suspension for pelvic organ prolapse. Concomitant procedures such as hysterectomy, midurethral sling, and anterior or posterior colporrhaphy were allowed. Enrolled participants underwent dynamic pelvic imaging pre- and postoperatively. Radiographic and anatomic measurements were compared. Secondary outcomes included validated patient questionnaires.

Results

Fourteen participants were included in the analysis. The mean age was 62 years; all participants were Caucasian. Most participants had stage III pelvic organ prolapse. Significant improvements were noted in several radiographic measurements. The average H-line (representing levator hiatus width) with straining maneuvers improved following surgery (7.2 cm preoperatively vs. 6.6 cm postoperatively, p = 0.015). The average M-line (representing levator muscular descent) improved significantly with both straining (4.0 cm preoperatively vs. 3.0 cm postoperatively, p < 0.001) and defecatory maneuvers (6.2 cm preoperatively vs. 5.2 cm postoperatively, p = 0.001). The average size of cystocele improved from 5.6 cm (moderate) preoperatively to 0.7 cm (absent descent) postoperatively (p < 0.001). The average descent of the vaginal apex with defecation preoperatively was 3.0 cm (moderate) and 0 cm (absent descent) postoperatively (p = 0.003). Posterior compartment descent with defecation did not change following surgical intervention (5.8 cm preoperatively vs. 5.2 cm postoperatively, p = 0.056). Pelvic Organ Prolapse Quantification measurements improved in all compartments, and Pelvic Floor Distress Inventory-20 scores improved significantly following surgery (102 preoperatively vs. 30 postoperatively, p < 0.001).

Conclusions

Native tissue reconstruction with intraperitoneal vaginal vault suspension resulted in significant anatomic improvements, as defined by physical examination and dynamic magnetic resonance imaging.
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Metadata
Title
Dynamic magnetic resonance imaging following native tissue vaginal reconstructive surgery; a prospective study
Authors
Abigail Shatkin-Margolis
Eugene Duke
Vivian Ghodsi
Austin Hill
Catrina C. Crisp
Rachel N. Pauls
Publication date
01-06-2021
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 6/2021
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-020-04571-3

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