Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
Department of Radiology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
Neurourol Urodyn. 2019 Apr;38(4):1142-1151. doi: 10.1002/nau.23970. Epub 2019 Mar 8.
To compare postoperative vaginal axis (VA) following vaginal sacrospinous fixation (VSF) or abdominal sacrocolpopexy (ASC) using magnetic resonance imaging (MRI) at postoperative period, in a randomized sample.
Seventy-one patients randomized to VSF with an anterior mesh or ASC were recruited with a mean 27-month follow-up for pelvic MRI; 40 patients underwent the examination. VA was calculated in relation to the pelvic inclination correction line. All patients were submitted to physical examination according to the pelvic organ prolapse quantification system, subjective impression questionnaires and quality of life (QoL) questionnaires (International Consultation on Incontinence Questionnaire, ICIQ). Objective failure was defined as points Ba, Bp, or C > 0. Subjective cure was defined as questions 5a and 6a from the ICIQ-VS questionnaire equal to zero.
VA exhibited two portions (inferior and medium). Mean medium axis was equally more obtuse in VSF (85.9° ± 9.9°; P < 0.001) and ASC (87.1° ± 14.7°; P < 0.001) groups, with no difference between them. Mean inferior axis was more acute for both groups (VSF, 72.5° ± 19.1°, P < 0.001; ASC, 75.7° ± 15.5°, P < 0.001). All women had normal medium axes and 47.5% had inferior axis values above the 95th or below the fifth percentile, without differences regarding type of surgery performed. Women with abnormal vs normal VA did not present any difference regarding pre or postoperative physical examination, demographic characteristics, objective or subjective cure, patient satisfaction, QoL scores, or sexuality.
Both VSF and ASC deviate the physiological VA, both in its medium and inferior portions, where values fall outside normality percentiles. However, this alteration was not associated with worse objective, subjective, QoL, or sexual outcomes.
通过术后磁共振成像（MRI）比较阴道骶骨固定术（VSF）或腹式骶骨阴道固定术（ASC）术后阴道轴（VA），本研究为随机样本。
71 例患者随机分为接受前部网片 VSF 或 ASC 治疗组，平均随访 27 个月后行盆腔 MRI 检查；40 例患者接受了检查。VA 是根据骨盆倾斜矫正线计算的。所有患者均根据盆腔器官脱垂量化系统进行体格检查、主观印象问卷和生活质量（QoL）问卷（国际尿失禁咨询问卷，ICIQ）。客观失败定义为 Ba、Bp 或 C 点>0。主观治愈定义为 ICIQ-VS 问卷的问题 5a 和 6a 等于 0。
VA 呈现两个部分（下和中）。VSF（85.9°±9.9°；P<0.001）和 ASC（87.1°±14.7°；P<0.001）组的中轴平均更钝，两组间无差异。下轴对于两组均更锐角（VSF，72.5°±19.1°；P<0.001；ASC，75.7°±15.5°；P<0.001）。所有女性的中轴均正常，47.5%的下轴值位于第 95 百分位以上或第 5 百分位以下，与手术类型无关。VA 异常与正常的女性在术前或术后体格检查、人口统计学特征、客观或主观治愈、患者满意度、QoL 评分或性生活方面均无差异。
VSF 和 ASC 都改变了生理 VA，无论是中轴还是下轴，其值均落在正常值范围之外。然而，这种改变与较差的客观、主观、QoL 或性生活结果无关。
