Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
Int Urogynecol J. 2023 Aug;34(8):1923-1931. doi: 10.1007/s00192-023-05482-9. Epub 2023 Feb 18.
Our objective was to develop a standardized measurement system to evaluate structural support site failures among women with anterior vaginal wall-predominant prolapse according to increasing prolapse size using stress three-dimensional (3D) magnetic resonance imaging (MRI).
Ninety-one women with anterior vaginal wall-predominant prolapse and uterus in situ who had undergone research stress 3D MRI were included for analysis. The vaginal wall length and width, apex and paravaginal locations, urogenital hiatus diameter, and prolapse size were measured at maximal Valsalva on MRI. Subject measurements were compared to established measurements in 30 normal controls without prolapse using a standardized z-score measurement system. A z-score greater than 1.28, or the 90 percentile in controls, was considered abnormal. The frequency and severity of structural support site failure was analyzed based on tertiles of prolapse size.
Substantial variability in support site failure pattern and severity was identified, even between women with the same stage and similar size prolapse. Overall, the most common failed support sites were straining hiatal diameter (91%) and paravaginal location (92%), followed by apical location (82%). Impairment severity z-score was highest for hiatal diameter (3.56) and lowest for vaginal width (1.40). An increase in impairment severity z-score was observed with increasing prolapse size among all support sites across all three prolapse size tertiles (p < 0.01 for all).
We identified substantial variation in support site failure patterns among women with different degrees of anterior vaginal wall prolapse using a novel standardized framework that quantifies the number, severity, and location of structural support site failures.
我们的目的是开发一种标准化的测量系统，根据脱垂的大小，使用压力三维（3D）磁共振成像（MRI）评估有前阴道壁为主的脱垂的女性的结构支撑部位的失败。
共纳入 91 例有前阴道壁为主的脱垂和子宫在位的女性，她们都进行了研究性压力 3D MRI。在 MRI 上最大 Valsalva 时测量阴道壁长度和宽度、顶点和阴道旁位置、尿生殖膈间隙直径和脱垂大小。将受试者测量值与 30 例无脱垂的正常对照者的既定测量值进行比较，使用标准化 z 评分测量系统。z 评分大于 1.28 或对照组的第 90 百分位数被认为是异常的。根据脱垂大小的三分位数分析结构支撑部位失败的频率和严重程度。
即使在同一阶段和相似大小脱垂的女性之间，也发现了支持部位失败模式和严重程度的显著差异。总体而言，最常见的失败支撑部位是收缩裂孔直径（91%）和阴道旁位置（92%），其次是顶点位置（82%）。裂孔直径的损伤严重程度 z 评分最高（3.56），阴道宽度最低（1.40）。在所有三个脱垂大小三分位数中，所有支撑部位的脱垂大小越大，损伤严重程度 z 评分越高（所有 p<0.01）。
我们使用一种新的标准化框架，该框架量化了结构支撑部位失败的数量、严重程度和位置，确定了不同程度的前阴道壁脱垂女性的支持部位失败模式存在很大差异。
