70: Dynamic magnetic resonance imaging of pelvic anatomy following vaginal reconstructive surgery: A prospective study

Abstract

To describe the impact of native tissue vaginal reconstruction, including vaginal vault suspension, on pelvic anatomy using dynamic magnetic resonance imaging (MRI). This IRB approved prospective cohort study investigated women undergoing intraperitoneal vaginal vault suspension for symptomatic pelvic organ prolapse (POP) with native tissue reconstruction. Enrolled participants underwent dynamic pelvic MRI preoperatively and 3 months postoperatively. Radiographic and anatomic measurements were compared. The H-line (or levator hiatus) was defined as the distance from the pubic symphysis to the posterior anal canal and the M-line (or muscular pelvic floor relaxation) was defined as the decent of the levator plate from the pubococcygeal line (PCL). The PCL represented the level of the pelvic floor and was measured from the inferior border of the pubic symphysis to the last coccygeal joint. Our primary outcome was to compare preoperative MRI measurements to those following surgical treatment. Secondary outcomes were evaluated via validated patient questionnaires pre- and post-operatively. A total of 17 participants were enrolled, 14 completed the study and were included in our analysis. The mean age was 62 years; all participants were white. The majority of participants had Stage III POP, as defined by the Pelvic Organ Prolapse Quantification (POP-Q) scale. Twelve participants (85.7%) underwent a concomitant hysterectomy and 5 participants (35.7%) received a concomitant midurethral sling procedure. There was a significant improvement in several radiographic measurements with straining and/or defecation following vaginal reconstruction, including the H-line, M-line, anorectal angle, and the extent of apical and anterior compartment prolapse. There was no difference regarding pubococcygeal line (PCL), anorectal decent, extent of enterocele, or posterior compartment prolapse. POP-Q measurements improved significantly in all compartments with the exception of perineal body and total vaginal length. Regarding validated questionnaires, PFDI-20 scores improved significantly (102 preop vs. 30 postop, p<0.001) following surgery. While PFIQ-7 scores also improved, this finding did not achieve significance (55 preop vs 24 postop, p=0.164). Native tissue reconstruction with intraperitoneal vaginal vault suspension for symptomatic pelvic organ prolapse not only improves pelvic anatomy and function as defined by POP-Q measurements and PFDI scores, but is also associated with significantly improved measurements on dynamic MRI at 3 months postoperatively.