Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: a randomised study.

OBJECTIVE

To compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP).

MATERIALS AND METHODS

Twenty-one patients with vault prolapse requiring surgical treatment were randomly assigned in a balanced way to undergo SSF (n = 7), PIVS (n = 7) or SCP (n = 7). The magnetic resonance imaging of the pelvis were performed preoperatively and at 6-12 weeks postoperatively to assess the vaginal configuration using the method described previously. The two main angles measured were: (i) the angle between the lower vagina and pubococcygeal line 'd-angle' (normal: 53 +/- 15 degrees ); and (ii) the angle between the lower and upper vagina planes 'e-angle' (normal: 145 +/- 7 degrees ).

RESULTS

The mean preoperative/postoperatively measured d-angles were 69 degrees /62 degrees, 58 degrees /70 degrees, and 49 degrees /52 degrees for SSF, PIVS and SCP, respectively. The corresponding means for the e-angle were 173 degrees /215 degrees, 189 degrees /146 degrees, and 205 degrees /149 degrees. The changes of the e-angles proved to be statistically significant (P < 0.05) in each surgical group, while no significant change in the d-angle could be found in any of the three groups.

CONCLUSIONS

Significant improvements in the restoration of vaginal configuration were achieved in patients who underwent PIVS or SCP. Sacrospinous fixation in contrast seems to increase anatomical distortion of the vaginal configuration.