Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study
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Le résumé fourni par la source
OBJECTIVE: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. DESIGN: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. SETTING: Eight clinical sites in the US Pelvic Floor Disorders Network. POPULATION OR SAMPLE: Women 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. METHODS: The 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 MEASURES: Vaginal 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. RESULTS: Of 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. CONCLUSIONS: Vaginal 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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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé, mais le titre doit être comparé manuellement.
- Titre Crossref
- Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the <scp>DEMAND</scp> study
- Date Crossref
- 31/07/2023
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Pittsburgh Department of Bioengineering pays non établi dans la noticeUniversité ou école supérieure
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Magee-Womens Research Institute pays non établi dans la noticeStructure de recherche
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University of Pittsburgh Medical Center pays non établi dans la noticeÉtablissement de santé
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Duke University Division of Urogynecology pays non établi dans la noticeUniversité ou école supérieure
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University of Alabama at Birmingham Division of Urogynecology and Pelvic Reconstructive Surgery pays non établi dans la noticeUniversité ou école supérieure
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Brown University Division of Urogynecology pays non établi dans la noticeUniversité ou école supérieure
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Institute for Female Pelvic Medicine and Reconstructive Surgery pays non établi dans la noticeÉtablissement de santé
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University of Pennsylvania Department of Obstetrics and Gynecology pays non établi dans la noticeUniversité ou école supérieure
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University of California San Diego Department of Radiology pays non établi dans la noticeUniversité ou école supérieure
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National Institutes of Health pays non établi dans la noticeOrganisme public
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Eunice Kennedy Shriver National Institute of Child Health and Human Development pays non établi dans la noticeStructure de recherche
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Pharmaceutical Product Development (United States) pays non établi dans la noticeEntreprise
Department of Bioengineering — University of Pittsburgh, Magee-Womens Research Institute et University of Pittsburgh Medical Center, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.