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
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
› Institutsangaben

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.

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.




Publikationsverlauf

Eingereicht: 14. April 2020

Angenommen: 10. August 2020

Artikel online veröffentlicht:
29. Januar 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/)

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