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Introduction and Hypothesis <p>Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence.</p> Methods <p>This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health &amp; Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30–42&#xa0;months after surgery or prior to 30&#xa0;months if undergoing reoperation for recurrence.</p> Results <p>Of the 88 participants analyzed (aged 65 ± 7.7&#xa0;years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, <i>p</i> = 0.14. Larger genital hiatus (H-line, 86.5&#xa0;mm vs 72.3&#xa0;mm, <i>p</i> = 0.003), low posterior position during strain (M-line, 55.6&#xa0;mm vs 40.3&#xa0;mm, <i>p</i> = 0.005), and apical&#xa0;compartments (vaginal apex position below pubococcygeal line (PCL), 42.1&#xa0;mm vs 13.1&#xa0;mm, <i>p</i> &lt; 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3&#xa0;mm vs 41.3&#xa0;mm, <i>p</i> = 0.04), vaginal circumference (108.5&#xa0;mm vs 96.1&#xa0;mm, <i>p</i> = 0.03), and bladder descent vs successes.</p> Conclusions <p>Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.</p>

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MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Mark E. Lockhart,
  • Pamela A. Moalli,
  • Holly E. Richter,
  • Isuzu Meyer,
  • Allison C. Weidner,
  • Yuko M. Komesu,
  • Benjamin Carper,
  • Marie G. Gantz,
  • Kimberly Ferrante,
  • Sherella Johnson,
  • Emily S. Lukacz,
  • Charles W. Nager,
  • Gouri B. Diwadkar,
  • Keisha Y. Dyer,
  • Linda M. Mackinnon,
  • Jasmine Tan-Kim,
  • Gisselle Zazueta-Damian,
  • Cindy Amundsen,
  • Yasmeen Bruton,
  • Notorious Coleman-Taylor,
  • Amie Kawasaki,
  • Nicole Longoria,
  • Shantae McLean,
  • Nazema Siddiqui,
  • Alison Weidner,
  • Kathy Carter,
  • R. Edward Varner,
  • David R. Ellington,
  • Sunita Patel,
  • Nancy Saxon,
  • Velria B. Willis,
  • Cassandra Carberry,
  • B. Star Hampton,
  • Nicole Korbly,
  • Ann S. Meers,
  • Deborah L. Myers,
  • Charles R. Rardin,
  • Vivian W. Sung,
  • Kyle Wohlrab,
  • Gena Dunivan,
  • Peter Jeppson,
  • Rebecca G. Rogers,
  • Lily Arya,
  • Lorraine Flick,
  • Heidi Harvie,
  • Michelle Kinglee,
  • Ariana Smith,
  • Steven D. Abramowitch,
  • Michael Bonidie,
  • Shaniel Bowen,
  • Judy Gruss,
  • Jonathan Shepherd,
  • Gary Sutkin,
  • Halina M. Zyczynski,
  • Matthew Barber,
  • Annette Graham,
  • Marie Fidela R. Paraiso,
  • Cecile Ferrando,
  • Donna Mazloomdoost,
  • Kate Burdekin,
  • Michael Ham,
  • Amanda Shaffer,
  • Amaanti Sridhar,
  • Dennis Wallace,
  • Ryan Whitworth,
  • Taylor Swankie

摘要

Introduction and Hypothesis

Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence.

Methods

This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health & Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30–42 months after surgery or prior to 30 months if undergoing reoperation for recurrence.

Results

Of the 88 participants analyzed (aged 65 ± 7.7 years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, p = 0.14. Larger genital hiatus (H-line, 86.5 mm vs 72.3 mm, p = 0.003), low posterior position during strain (M-line, 55.6 mm vs 40.3 mm, p = 0.005), and apical compartments (vaginal apex position below pubococcygeal line (PCL), 42.1 mm vs 13.1 mm, p < 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3 mm vs 41.3 mm, p = 0.04), vaginal circumference (108.5 mm vs 96.1 mm, p = 0.03), and bladder descent vs successes.

Conclusions

Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.