Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

for the NICHD Pelvic Floor Disorders Network

doi:10.1111/1471-0528.17620

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

for the NICHD Pelvic Floor Disorders Network

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Objective: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. Design: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. Setting: Eight clinical sites in the US Pelvic Floor Disorders Network. Population or Sample: 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. Methods: 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. Main outcome measures: 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. Results: 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. Conclusions: 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.

Original language	English (US)
Pages (from-to)	267-277
Number of pages	11
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	131
Issue number	3
DOIs	https://doi.org/10.1111/1471-0528.17620
State	Published - Feb 2024

Funding

All of the authors report funding from the National Institute of Child Health and Human Development (NICHD) and the National Institutes of Health Office of Research on Women's Health; Boston Scientific Corporation provided partial support through a research grant to the Pelvic Floor Disorders Network (PFDN) Data Coordinating Center, RTI International. PAM has received research support from the NICHD; SDA has received research support from the NICHD and Renovia Inc.; CRR has received research support from the NICHD, Reia LLC and the Foundation for Female Health Awareness; and MEH has received research support from General Electric and serves as a consultant to HealthLytix. No other disclosures were declared. Eunice Kennedy Shriver In addition to the authors, the following members of the Pelvic Floor Disorders Network were involved in the Defining the Mechanisms of Anterior Vaginal Wall Descent study: UC San Diego Health, San Diego, CA: Kimberly Ferrante, Sherella Johnson, Emily S. Lukacz, Charles W. Nager. Kaiser Permanente, San Diego, CA: Gouri B. Diwadkar, Keisha Y. Dyer, Linda M. Mackinnon, Jasmine Tan-Kim, Gisselle Zazueta-Damian. Duke University Medical Center, Durham, NC: Cindy Amundsen, Yasmeen Bruton, Notorious Coleman-Taylor, Amie Kawasaki, Shantae McLean, Nazema Siddiqui, Alison Weidner. University of Alabama at Birmingham, Dept. OB/GYN, Birmingham, AL: Kathy Carter, David Ellington, Mark E. Lockhart, Sunita Patel, Holly E. Richter, Nancy Saxon, Velria B. Willis. Alpert Medical School of Brown University, Providence, RI: Cassandra Carberry, B. Star Hampton, Nicole Korbly, Ann S. Meers, Deborah L. Myers, Vivian W. Sung, Elizabeth-Ann Viscione, Kyle Wohlrab. University of New Mexico: Gena Dunivan, Yuko Komesu, Peter Jeppson. University of Pennsylvania, Philadelphia, PA: Lily Arya, Lorraine Flick, Michelle Kingslee, Ariana Smith. Magee-Women's Hospital, Dept. of OB/GYN & Reproductive Sciences, Pittsburgh, PA: Michael Bonidie, Judy Gruss, Jonathan Shepherd, Gary Sutkin, Halina M. Zyczynski. Cleveland Clinic Foundation, Cleveland, OH: Matthew Barber, Annette Graham, Marie Fidela R. Paraiso, Cecile Ferrando. Albany Medical College, Albany, NY: Rebecca G. Rogers. RTI International, Research Triangle Park, NC: Kate Burdekin, Michael Ham, Amaanti Sridhar, Dennis Wallace, Ryan Whitworth, Taylor Swankie.

Keywords

MRI
angulation
dimension
hysterectomy
hysteropexy
pelvic organ prolapse
position
prolapse recurrence
vagina
vaginal mesh

ASJC Scopus subject areas

Obstetrics and Gynecology

Access to Document

10.1111/1471-0528.17620

Cite this

@article{e03a172b5ab64dd5b97a6642e25e5ee3,

title = "Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study",

abstract = "Objective: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. Design: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. Setting: Eight clinical sites in the US Pelvic Floor Disorders Network. Population or Sample: 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. Methods: 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. Main outcome measures: 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. Results: 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. Conclusions: 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.",

keywords = "MRI, angulation, dimension, hysterectomy, hysteropexy, pelvic organ prolapse, position, prolapse recurrence, vagina, vaginal mesh",

author = "{for the NICHD Pelvic Floor Disorders Network} and Bowen, {Shaniel T.} and Moalli, {Pamela A.} and Abramowitch, {Steven D.} and Douglas H Luchristt and Isuzu Meyer and Rardin, {Charles R.} and Harvie, {Heidi S.} and Michael E Hahn and Donna Mazloomdoost and Pooja Iyer and Benjamin Carper and Marie G Gantz and Kimberly Ferrante and Sherella Johnson and Lukacz, {Emily S.} and Nager, {Charles W.} and Diwadkar, {Gouri B.} and Dyer, {Keisha Y.} and Mackinnon, {Linda M.} and Jasmine Tan-Kim and Gisselle Zazueta-Damian and Cindy Amundsen and Yasmeen Bruton and Notorious Coleman-Taylor and Amie Kawasaki and Shantae McLean and Nazema Siddiqui and Alison Weidner and Kathy Carter and David Ellington and Lockhart, {Mark E.} and Sunita Patel and Richter, {Holly E.} and Nancy Saxon and Willis, {Velria B.} and Cassandra Carberry and Hampton, {B. Star} and Nicole Korbly and Meers, {Ann S.} and Myers, {Deborah L.} and Sung, {Vivian W.} and Viscione, {Elizabeth Ann} and Kyle Wohlrab and Gena Dunivan and Yuko Komesu and Peter Jeppson and Lily Arya and Lorraine Flick and Michelle Kingslee and Ariana Smith",

note = "Publisher Copyright: {\textcopyright} 2023 John Wiley & Sons Ltd.",

year = "2024",

month = feb,

doi = "10.1111/1471-0528.17620",

language = "English (US)",

volume = "131",

pages = "267--277",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "John Wiley and Sons Inc.",

number = "3",

}

TY - JOUR

T1 - Vaginal morphology and position associated with prolapse recurrence after vaginal surgery

T2 - A secondary analysis of the DEMAND study

AU - for the NICHD Pelvic Floor Disorders Network

AU - Bowen, Shaniel T.

AU - Moalli, Pamela A.

AU - Abramowitch, Steven D.

AU - Luchristt, Douglas H

AU - Meyer, Isuzu

AU - Rardin, Charles R.

AU - Harvie, Heidi S.

AU - Hahn, Michael E

AU - Mazloomdoost, Donna

AU - Iyer, Pooja

AU - Carper, Benjamin

AU - Gantz, Marie G

AU - Ferrante, Kimberly

AU - Johnson, Sherella

AU - Lukacz, Emily S.

AU - Nager, Charles W.

AU - Diwadkar, Gouri B.

AU - Dyer, Keisha Y.

AU - Mackinnon, Linda M.

AU - Tan-Kim, Jasmine

AU - Zazueta-Damian, Gisselle

AU - Amundsen, Cindy

AU - Bruton, Yasmeen

AU - Coleman-Taylor, Notorious

AU - Kawasaki, Amie

AU - McLean, Shantae

AU - Siddiqui, Nazema

AU - Weidner, Alison

AU - Carter, Kathy

AU - Ellington, David

AU - Lockhart, Mark E.

AU - Patel, Sunita

AU - Richter, Holly E.

AU - Saxon, Nancy

AU - Willis, Velria B.

AU - Carberry, Cassandra

AU - Hampton, B. Star

AU - Korbly, Nicole

AU - Meers, Ann S.

AU - Myers, Deborah L.

AU - Sung, Vivian W.

AU - Viscione, Elizabeth Ann

AU - Wohlrab, Kyle

AU - Dunivan, Gena

AU - Komesu, Yuko

AU - Jeppson, Peter

AU - Arya, Lily

AU - Flick, Lorraine

AU - Kingslee, Michelle

AU - Smith, Ariana

PY - 2024/2

Y1 - 2024/2

N2 - Objective: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. Design: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. Setting: Eight clinical sites in the US Pelvic Floor Disorders Network. Population or Sample: 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. Methods: 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. Main outcome measures: 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. Results: 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. Conclusions: 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.

AB - Objective: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. Design: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. Setting: Eight clinical sites in the US Pelvic Floor Disorders Network. Population or Sample: 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. Methods: 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. Main outcome measures: 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. Results: 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. Conclusions: 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.

KW - MRI

KW - angulation

KW - dimension

KW - hysterectomy

KW - hysteropexy

KW - pelvic organ prolapse

KW - position

KW - prolapse recurrence

KW - vagina

KW - vaginal mesh

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U2 - 10.1111/1471-0528.17620

DO - 10.1111/1471-0528.17620

M3 - Article

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AN - SCOPUS:85166666757

SN - 1470-0328

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JO - BJOG: An International Journal of Obstetrics and Gynaecology

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ER -

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

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