Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(01): 046-053
DOI: 10.1055/s-0040-1718441
Original Article
Surgery

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

Resultados de ressonância magnética de médio a longo prazos de duas cirurgias de prolapso por defeito apical: Uma análise secundária de um ensaio clínico randomizado
Luiz Carlos Santos Junior 
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Luiz Gustavo Oliveira Brito 
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Edilson Benedito de Castro 
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Sergio Dertkigil 
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Cassia Raquel Teatin Juliato 
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

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.

Resumo

Objetivo A ressonância magnética (RM) tem sido considerada uma outra ferramenta para uso pré e pós-operatório em casos de prolapso de órgãos pélvicos. Contudo, pouco consenso existe sobre a sua prática para prolapso e a associação entre as linhas de referência da RM e o exame físico. Nós objetivamos avaliar resultados de médio a longo prazo de duas técnicas cirúrgicas para prolapso apical.

Métodos Um total de 40 mulheres com prolapso apical foram submetidas entre 2014 a 2016 a sacrocolpopexia abdominal (grupo SCA; n = 20) ou fixação bilateral vaginal no ligamento sacroespinhoso com tela anterior (grupo FVLS-TA; n = 20). Os exames físicos com estadiamento usando o Pelvic Organ Prolapse Quantification System (POP-Q: cura objetiva), e o International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: cura subjetiva) foram analisados antes e depois de um ano da cirurgia, respectivamente. O exame de RM (linha pubococcígea [LPC], base vesical [BV], junção anorretal [JAR] e o volume subtendido estimado do levantador do ânus [VSELA]) foi realizado um ano antes da cirurgia. Estabeleceu-se o nível de significância em 5%.

Resultados Depois de uma média de 27 meses de seguimento, de acordo com a RM, 60% das mulheres foram curadas no grupo FVLS-TA versus 45% no grupo SCA (p = 0.52). As curas objetivas associadas ao POP-Q e à RM foram correlacionadas na parede vaginal anterior (p = 0.007), mas nenhuma correlação foi encontrada com a cura subjetiva. O VSELA foi maior entre as pacientes com fracasso da cirurgia, e um ponto de corte de ≥ 33.5 mm3 esteve associado ao fracasso da cirurgia (area sob a curva característica de operação do receptor [COR]: 0.813; p = 0.002).

Conclusão Ambas as cirurgias para o prolapso foram similares nas curas objetivas tanto pelo POP-Q quanto pela RM. Áreas maiores de VSELA estiveram associadas com o fracasso das cirurgias.

Keywords

pelvic organ prolapse - magnetic resonance imaging - cross-sectional studies

Palavras-chave

prolapso dos órgãos pélvicos - ressonância magnética - estudos transversais

Contributions

All authors of the present study made substantial contributions to conception and design, data collection or analysis, and interpretation of data; participated in the writing of the article or critical review of the intellectual content, and provided final approval of the version to be published.




Publication History

Received: 14 April 2020

Accepted: 10 August 2020

Article published online:
29 January 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J. et al; Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008; 300 (11) 1311-1316 DOI: 10.1001/jama.300.11.1311.
    CrossrefPubMedGoogle Scholar
  • 2 Gousse AE, Barbaric ZL, Safir MH, Madjar S, Marumoto AK, Raz S. Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis. J Urol 2000; 164 (05) 1606-1613 DOI: 10.1016/S0022-5347(05)67040-1.
    CrossrefPubMedGoogle Scholar
  • 3 Comiter CV, Vasavada SP, Barbaric ZL, Gousse AE, Raz S. Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 1999; 54 (03) 454-457 DOI: 10.1016/s0090-4295(99)00165-x.
    CrossrefPubMedGoogle Scholar
  • 4 Pizzoferrato AC, Nyangoh Timoh K, Fritel X, Zareski E, Bader G, Fauconnier A. Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when?. Eur J Obstet Gynecol Reprod Biol 2014; 181: 259-266 DOI: 10.1016/j.ejogrb.2014.07.025.
    CrossrefPubMedGoogle Scholar
  • 5 Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 1991; 179 (01) 25-33 DOI: 10.1148/radiology.179.1.2006286.
    CrossrefPubMedGoogle Scholar
  • 6 El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L. et al; ESUR and ESGAR Pelvic Floor Working Group. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. Eur Radiol 2017; 27 (05) 2067-2085 DOI: 10.1007/s00330-016-4471-7.
    CrossrefPubMedGoogle Scholar
  • 7 DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM. et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 2007; 109 (2 Pt 1): 295-302 DOI: 10.1097/01.AOG.0000250901.57095.ba.
    CrossrefPubMedGoogle Scholar
  • 8 Rodrigues Junior AA, Herrera-Hernadez MC, Bassalydo R, McCullough M, Terwilliger HL, Downes K, Hoyte L. et al. Estimates of the levator ani subtended volume based on magnetic resonance linear measurements. Neurourol Urodyn 2016; 35 (02) 199-205 DOI: 10.1002/nau.22691.
    CrossrefPubMedGoogle Scholar
  • 9 Wyman AM, Rodrigues Jr AA, Hahn L, Greene KA, Bassaly R, Hart S. et al. Estimated levator ani subtended volume: a novel assay for predicting surgical failure after uterosacral ligament suspension. Am J Obstet Gynecol 2016; 214 (05) 611.e1-611.e6 DOI: 10.1016/j.ajog.2015.11.005.
    CrossrefPubMedGoogle Scholar
  • 10 Juliato CRT, Santos-Junior LC, de Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation-a randomized trial. Neurourol Urodyn 2019; 38 (04) 1142-1151 DOI: 10.1002/nau.23970.
    CrossrefPubMedGoogle Scholar
  • 11 de Castro EB, Brito LGO, Juliato CRT. Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study. Int Urogynecol J Pelvic Floor Dysfunct 2020; 31 (02) 365-372 DOI: 10.1007/s00192-019-03948-3.
    CrossrefPubMedGoogle Scholar
  • 12 Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarsko P. et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175 (01) 10-17 DOI: 10.1016/s0002-9378(96)70243-0.
    CrossrefPubMedGoogle Scholar
  • 13 Tamanini JT, Almeida FG, Girotti ME, Riccetto CL, Palma PC, Rios LA. The Portuguese validation of the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) for Brazilian women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (10) 1385-1391 DOI: 10.1007/s00192-008-0641-8.
    CrossrefPubMedGoogle Scholar
  • 14 Woodfield CA, Hampton BS, Sung V, Brody JM. Magnetic resonance imaging of pelvic organ prolapse: comparing pubococcygeal and midpubic lines with clinical staging. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20 (06) 695-701 DOI: 10.1007/s00192-009-0865-2.
    CrossrefPubMedGoogle Scholar
  • 15 Halligan S, Spence-Jones C, Kamm MA, Bartram CI. Dynamic cystoproctography and physiological testing in women with urinary stress incontinence and urogenital prolapse. Clin Radiol 1996; 51 (11) 785-790 DOI: 10.1016/s0009-9260(96)80006-7.
    CrossrefPubMedGoogle Scholar
  • 16 Hecht EM, Lee VS, Tanpitukpongse TP, Babb JS, Taouli B, Wong S. et al. MRI of pelvic floor dysfunction: dynamic true fast imaging with steady-state precession versus HASTE. AJR Am J Roentgenol 2008; 191 (02) 352-358 DOI: 10.2214/AJR.07.3403.
    CrossrefPubMedGoogle Scholar
  • 17 Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M. et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 2013; 309 (19) 2016-2024 DOI: 10.1001/jama.2013.4919.
    CrossrefPubMedGoogle Scholar
  • 18 Ginath S, Garely AD, Luchs JS, Shahryarinejad A, Olivera CK, Zhou S. et al. Magnetic resonance imaging of abdominal versus vaginal prolapse surgery with mesh. Int Urogynecol J Pelvic Floor Dysfunct 2012; 23 (11) 1569-1576 DOI: 10.1007/s00192-012-1783-2.
    CrossrefPubMedGoogle Scholar
  • 19 van der Weiden RM, Rociu E, Mannaerts GH, van Hooff MH, Vierhout ME, Withagen MI. Dynamic magnetic resonance imaging before and 6 months after laparoscopic sacrocolpopexy. Int Urogynecol J Pelvic Floor Dysfunct 2014; 25 (04) 507-515 DOI: 10.1007/s00192-013-2254-0.
    CrossrefPubMedGoogle Scholar
  • 20 Brocker KA, Alt CD, Rzepka J, Sohn C, Hallscheidt P. One-year dynamic MRI follow-up after vaginal mesh repair: evaluation of clinical, radiological, and quality-of-life results. Acta Radiol 2015; 56 (08) 1002-1008 DOI: 10.1177/0284185114544241.
    CrossrefPubMedGoogle Scholar
  • 21 Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 2001; 185 (06) 1332-1337 , discussion 1337–1338 DOI: 10.1067/mob.2001.119078.
    CrossrefPubMedGoogle Scholar
  • 22 Cimsit C, Yoldemir T, Akpinar IN. Prevalence of dynamic magnetic resonance imaging-identified pelvic organ prolapse in pre- and postmenopausal women without clinically evident pelvic organ descent. Acta Radiol 2016; 57 (11) 1418-1424 DOI: 10.1177/0284185115589123.
    CrossrefPubMedGoogle Scholar
  • 23 Broekhuis SR, Fütterer JJ, Barentsz JO, Vierhout ME, Kluivers KB. A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20 (06) 721-729 DOI: 10.1007/s00192-009-0848-3.
    CrossrefPubMedGoogle Scholar
  • 24 Attenberger UI, Morelli JN, Budjan J, Herold A, Kienle P, Kleine W. et al. The value of dynamic magnetic resonance imaging in interdisciplinary treatment of pelvic floor dysfunction. Abdom Imaging 2015; 40 (07) 2242-2247 DOI: 10.1007/s00261-015-0476-y.
    CrossrefPubMedGoogle Scholar