Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Magee Women's Research Institute, Pittsburgh, Pennsylvania, USA.
BJOG. 2024 Feb;131(3):267-277. doi: 10.1111/1471-0528.17620. Epub 2023 Jul 31.
To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.
Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study.
Eight clinical sites in the US Pelvic Floor Disorders Network.
Women who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015.
The MRI (rest, strain) obtained 30-42 months after surgery, or earlier for participants with recurrence who desired reoperation before 30 months, were analysed. MRI-based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three-dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position.
Vaginal angulation (upper, lower and upper-lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume) and position (apex, mid-vagina) at rest.
Of the 82 women analysed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (p = 0.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (p = 0.01) and mid-vagina (p = 0.01) at rest than women with successful surgery.
Vaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.
确定与阴道手术后脱垂复发相关的阴道形态和位置因素。
横断面研究“定义前阴道壁下降机制”中磁共振成像（MRI）的二次分析。
美国盆底疾病网络的 8 个临床站点。
2013 年 4 月至 2015 年 2 月期间因子宫阴道脱垂接受阴道网片悬吊带（吊带）子宫固定术或阴道子宫切除术（子宫切除术）的女性。
分析术后 30-42 个月（或更早）获得的 MRI（静息、张力），或对于在 30 个月前有复发且希望在 30 个月前再次手术的参与者。MRI 定义的脱垂复发是指在 MRI 张力下阴道超过处女膜。阴道节段（静息）用于创建三维模型，放置在形态计量算法中以量化和比较阴道形态（角度、尺寸）和位置。
静息时阴道角度（矢状面和冠状面的上、下和上下阴道角）、尺寸（长度、最大横宽、表面积、体积）和位置（顶点、阴道中段）。
在 82 名接受分析的女性中，吊带组 12/41（29%）和子宫切除术组 22/41（54%）有脱垂复发。吊带组中复发的女性在静息时阴道上段更偏向外侧（p=0.02），而手术成功的女性则没有。子宫切除术组中复发的女性阴道顶点（p=0.01）和阴道中段（p=0.01）在静息时位置较低，而手术成功的女性则没有。
阴道角度和位置与脱垂复发有关，提示与手术技术相关的阴道支撑机制和潜在的未解决的解剖缺陷。未来对脱垂手术前后女性的前瞻性研究可能会区分这两个因素。
