Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
Neurourol Urodyn. 2021 Nov;40(8):1989-1998. doi: 10.1002/nau.24781. Epub 2021 Sep 6.
The aim of this study was to develop and test the feasibility of a magnetic resonance imaging (MRI)-based measurement strategy to evaluate the effectiveness of surgical procedures in restoring normal anatomy in all three systems of pelvic floor support and quantify the structural changes induced by prolapse surgery.
Patients underwent clinical examination and stress MRI preoperatively and again 3 months postoperatively. Preoperative and postoperative measures of three MRI-based structural support systems were made: (1) vaginal wall, (2) apical and paravaginal support, and (3) hiatal closure system. Preoperative to postoperative structural changes were calculated and compared to normal values, and bivariate associations were determined.
The three structural support systems were successfully quantified for both preoperative and postoperative MRIs regardless of operative approaches in all 15 women in the pilot group. Apical support was restored to normal in 11 of 12 patients who underwent an apical suspension procedure and 9 of 14 patients with a posterior repair had normalization of genital hiatus size. Mid-vaginal paravaginal location was elevated an average of 2.5 ± 2.0 cm despite no paravaginal repairs being performed. Paravaginal location improvements were also significantly correlated with apical elevation (r values 0.99-0.87, p < 0.001).
A strategy that quantifies structural-specific preoperative impairments and improvements after prolapse surgery was successfully developed. Early findings reveal that prolapse surgery is more successful in restoring normal anatomy at Level I than Level III. Improvement in paravaginal location is significantly correlated with apical elevation.
本研究旨在开发和测试一种基于磁共振成像（MRI）的测量策略，以评估手术程序在恢复所有三个盆底支撑系统的正常解剖结构方面的有效性，并量化脱垂手术引起的结构变化。
患者在术前和术后 3 个月接受临床检查和压力 MRI。对三种基于 MRI 的结构支撑系统进行术前和术后测量：（1）阴道壁，（2）顶点和阴道旁支撑，（3）疝口闭合系统。计算术前到术后的结构变化，并与正常值进行比较，并确定双变量关联。
在试点组的 15 名女性中，无论手术方法如何，所有女性的术前和术后 MRI 均成功量化了这三个结构支撑系统。在接受顶点悬吊术的 12 名患者中，有 11 名患者的顶点支撑恢复正常，在接受后修补术的 14 名患者中，有 9 名患者的生殖裂孔大小恢复正常。尽管没有进行阴道旁修补术，但阴道中段旁阴道位置平均升高 2.5±2.0cm。阴道旁位置的改善与顶点抬高也有显著相关性（r 值为 0.99-0.87，p<0.001）。
成功开发了一种量化脱垂手术后结构特定的术前损伤和改善的策略。早期发现表明，脱垂手术在恢复 I 级解剖结构方面比恢复 III 级解剖结构更为成功。阴道旁位置的改善与顶点抬高显著相关。
