Triepels Charlotte P R, Boogaard Lars L, Fütterer Jurgen J, van Kuijk Sander M J, Spaans Wilbert A, Kruitwagen Roy F P M, Weemhoff Mirjam, Notten Kim J B
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
3D Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J Clin Med. 2024 Aug 15;13(16):4819. doi: 10.3390/jcm13164819.
Pelvic organ prolapse (POP) affects many women and is often managed with pessary treatment, yet predicting the success of fitting remains challenging. This study aims to identify anatomical parameters associated with successful and unsuccessful pessary treatment using dynamic magnetic resonance imaging (dMRI). A cross-sectional study in Maastricht University Medical Centre (MUMC+), the Netherlands. Sixteen women with a cystocele and/or descensus uteri minimal POP-Q stage 2, using pessary treatment, were included. All women underwent a dynamic MRI of the pelvic floor at rest, during contraction and on Valsalva. The anatomical parameters evaluated included various lengths and angles. The association between the anatomical parameters and pessary fitted is assessed using partial least squares regression. The predictive accuracy was tested using cross-validation based on the partial least squares model with the most important variables. Seven of the sixteen women (43.8%) were in the non-fitting group (due to movement, rotation or expulsion of the pessary), and nine women (56.3%) were in the fitting group. Participants in the non-fitting group had a significantly lower body mass index (BMI). Variables such as total vaginal length (TVL) and certain angles were highly predictive of pessary fitting success, with variable importance of projection (VIP) scores indicating their importance. The prediction models showed accuracies ranging from 53.3% to 80.0%. In this explorative study, TVL, cervical length (CL), sacrococcygeal angle and pubococcygeal angle were key variables associated with pessary fitting success. These findings offer valuable insights for optimizing pessary fitting procedures and the development of new pessaries.
盆腔器官脱垂（POP）影响着许多女性，通常采用子宫托治疗，但预测子宫托佩戴的成功率仍然具有挑战性。本研究旨在使用动态磁共振成像（dMRI）确定与子宫托治疗成功和失败相关的解剖学参数。这是一项在荷兰马斯特里赫特大学医学中心（MUMC+）进行的横断面研究。纳入了16名患有膀胱膨出和/或子宫脱垂且POP-Q分期为最低2期并采用子宫托治疗的女性。所有女性均在静息、收缩和瓦尔萨尔瓦动作时接受了盆底动态磁共振成像检查。评估的解剖学参数包括各种长度和角度。使用偏最小二乘回归评估解剖学参数与佩戴子宫托之间的关联。基于包含最重要变量的偏最小二乘模型，使用交叉验证测试预测准确性。16名女性中有7名（43.8%）属于佩戴失败组（由于子宫托移动、旋转或排出），9名女性（56.3%）属于佩戴成功组。佩戴失败组的参与者体重指数（BMI）显著更低。诸如总阴道长度（TVL）和某些角度等变量对子宫托佩戴成功具有高度预测性，投影变量重要性（VIP）评分表明了它们（这些变量）的重要性。预测模型的准确率在53.3%至80.0%之间。在这项探索性研究中，总阴道长度（TVL）、宫颈长度（CL）、骶尾角和耻骨尾骨角是与子宫托佩戴成功相关的关键变量。这些发现为优化子宫托佩戴程序和新型子宫托的研发提供了有价值的见解。
