Eijsink Julia J, Simmering Jaimy A, Perik Manon, van der Steen Annemarie, Grob Anique T M
Department of Gynecology, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
Multi-Modality Medical Imaging (M3i) Group, Technical Medical Centre, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
Int Urogynecol J. 2025 Feb;36(2):403-412. doi: 10.1007/s00192-024-06006-9. Epub 2024 Dec 20.
The high recurrence rate (up to 40%) of native tissue surgery for pelvic organ prolapse (POP) is concerning and a better understanding of the effect of surgery is essential in optimizing treatment. As physical examination (Pelvic Organ Prolapse-Quantification, POP-Q) underestimates the degree of prolapse, upright assessment may provide new insights. Therefore, we compared supine POP-Q with upright magnetic resonance imaging (MRI) examination of the anatomical effect of native tissue POP surgery on the pelvic anatomy.
This prospective study included 59 women with stage ≥ 2 anterior compartment prolapse undergoing solely anterior colporrhaphy (AC) or in combination with posterior colporrhaphy (PC), sacrospinous hysteropexy (SSH) or Manchester Fothergill (MF). Preoperatively and 6 weeks postoperatively, anatomical measurements were obtained: POP-Q and upright MRI. The Patient Global Impression of Improvement (PGI-I) questionnaire was completed 6 weeks postoperatively.
Significant lift of the lowest point of the bladder was observed on both POP-Q (37 ± 18 mm) and upright MRI (26 ± 22 mm), which was 10 ± 17 mm (p < 0.001) larger on POP-Q than on upright MRI. Symptomatic improvement (PGI-I) was reported by 93.2% of the patients, which showed a weak correlation with the bladder lift on upright MRI (Spearman's ρ -0.301, p = 0.021), but no correlation with the bladder lift on POP-Q (Spearman's ρ -0.078, p = 0.565).
The POP-Q examination overestimates the anatomical result of native tissue POP repair on the anterior vaginal wall by 1 cm compared with upright MRI examination upon 6 weeks' follow-up. Upright MRI examination is suggested to relate better to symptomatic outcome than does POP-Q examination.
盆腔器官脱垂（POP）自体组织手术的高复发率（高达40%）令人担忧，更好地了解手术效果对于优化治疗至关重要。由于体格检查（盆腔器官脱垂定量评估，POP-Q）会低估脱垂程度，直立位评估可能会提供新的见解。因此，我们比较了仰卧位POP-Q与直立位磁共振成像（MRI）检查自体组织POP手术对盆腔解剖结构的影响。
这项前瞻性研究纳入了59例前盆腔脱垂≥2期的女性，她们仅接受了前壁修补术（AC）或联合后壁修补术（PC）、骶棘韧带子宫悬吊术（SSH）或曼彻斯特手术（MF）。术前和术后6周进行解剖学测量：POP-Q和直立位MRI。术后6周完成患者总体改善印象（PGI-I）问卷。
POP-Q（37±18mm）和直立位MRI（26±22mm）均观察到膀胱最低点有显著提升，POP-Q上的提升比直立位MRI上大10±17mm（p<0.001）。93.2%的患者报告有症状改善（PGI-I），这与直立位MRI上膀胱提升呈弱相关（斯皮尔曼ρ=-0.301，p=0.021），但与POP-Q上膀胱提升无相关性（斯皮尔曼ρ=-0.078，p=0.565）。
随访6周时，与直立位MRI检查相比，POP-Q检查高估了自体组织POP修复对阴道前壁的解剖学效果1cm。建议直立位MRI检查比POP-Q检查与症状结局的相关性更好。
