Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial.

Abstract

OBJECTIVE\n\u2003Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse.\n\n\nMETHODS\n\u2003In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n\u2009=\u200920) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n\u2009=\u200920). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p\u2009<\u20090.05.\n\n\nRESULTS\n\u2003After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p\u2009=\u20090.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p\u2009=\u20090.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5\u2009mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p\u2009=\u20090.002).\n\n\nCONCLUSION\n\u2003Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.