Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.
Rev Bras Ginecol Obstet. 2021 Jan;43(1):46-53. doi: 10.1055/s-0040-1718441. Epub 2021 Jan 29.
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.
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 < 0.05.
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 ( = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall ( = 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 mm was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; = 0.002).
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.
磁共振成像（MRI）已被认为是用于管理盆腔器官脱垂（POP）的术前和术后期间的另一种工具。然而，对于 MRI 参考线与体格检查之间的实际应用，尚未达成共识。我们旨在评估两种用于治疗顶端脱垂的手术技术的中至长期结果。
共有 40 名患有顶端 POP 的女性于 2014 年至 2016 年期间被随机分为腹式骶骨阴道固定术（ASC 组，n=20）或双侧阴道骶棘韧带固定术加前网片（VSF-AM 组，n=20）。分别在术前和术后 1 年使用盆腔器官脱垂量化系统（POP-Q）进行分期（客观治愈）和国际尿失禁咨询问卷-阴道症状（ICIQ-VS：主观治愈）进行体格检查，并进行分析。所有 MRI 变量（耻骨尾骨线 [PCL]、膀胱底 [BB]、肛门直肠交界处 [ARJ] 和估计的肛提肌下容积 [eLASV]）在术后 1 年进行研究。差异有统计学意义定义为 < 0.05。
平均随访 27 个月后，根据 MRI 标准，VSF-AM 组的 60%女性治愈，而 ASC 组为 45%（ = 0.52）。在阴道前壁中，POP-Q 和 MRI 客观治愈率呈正相关（ = 0.007），但与主观治愈率无关。手术失败的患者的 eLASV 较大，并且 ≥ 33.5mm 的截断值与术后失败相关（受试者工作特征曲线下面积 [ROC]：0.813； = 0.002）。
两种手术方法在客观变量（POP-Q 测量和 MRI 治愈率）方面相似。较大的 eLASV 面积与手术失败相关。
