Dynamic magnetic resonance imaging to quantify pelvic organ mobility after treatment for uterine descent: differences be
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ORIGINAL ARTICLE
Dynamic magnetic resonance imaging to quantify pelvic organ mobility after treatment for uterine descent: differences between surgical procedures Mèlanie N. van IJsselmuiden 1 & Pauline Lecomte-Grosbras 2 & Jean-François Witz 2 & Mathias Brieu 2 & Michel Cosson 3 & Hugo W. F. van Eijndhoven 1 Received: 13 January 2020 / Accepted: 2 March 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Pelvic organ mobility is defined as the displacement of pelvic organs between rest and maximal straining. We hypothesized that pelvic organ mobility after vaginal sacrospinous hysteropexy (SSHP) might be increased compared with other surgeries for uterine descent, which may contribute to the high occurrence of postoperative cystocele after this surgery. Pelvic organ mobility and the vaginal axes after SSHP are compared with other surgical procedures for uterine descent: vaginal hysterectomy with uterosacral suspension (VH) and laparoscopic sacrohysteropexy (LSH). Methods In this prospective pilot study, 15 women were included (5 for each procedure). Six months postoperatively, POP-Q examination and dynamic MRI were performed and questionnaires were filled out regarding prolapse complaints. Pelvic organ mobility on MRI was defined as vertical displacement of pelvic organs at rest and maximal straining. The displacements and angles were measured using an image registration method. Furthermore, the angle of displacement of cervix/vaginal vault and vaginal axes were assessed. Results No anatomical recurrences of pelvic organ prolapse were found. No difference in pelvic organ mobility was demonstrated. After VH, a more posterior position of the upper vagina was found compared with SSHP and LSH. Conclusions Based on these data, the higher recurrence risk in the anterior compartment after SSHP cannot be explained. Larger sample sizes, studying women with recurrence or de novo cystocele after SSHP or using an upright MRI scanner would be of interest to further assess the relationship between pelvic organ mobility and the occurrence of anterior vaginal wall prolapse. Keywords Uterine prolapse . Pelvic organ prolapse . MRI . Pelvic organ mobility
Introduction Worldwide, vaginal hysterectomy (VH) with uterosacral suspension of the vaginal vault is the most important treatment for symptomatic uterovaginal prolapse [1]. However, a high
* Mèlanie N. van IJsselmuiden [email protected] 1
Department of Obstetrics and Gynecology, Isala Zwolle, PO Box 10500, 8000 GK Zwolle, The Netherlands
2
Univ. Lille, CNRS, Centrale Lille, FRE 2016—LamCube—Laboratoire de Mécanique Multiphysique Multiéchelle, 59000 Lille, France
3
Department of Obstetrics and Gynecology, Jeanne de Flandre hospital, Lille, France
proportion of women with prolapse symptoms prefer uterine preservation instead of hysterectomy [2, 3]. As a consequence, these preserving procedures are becoming more popular [4, 5]. Recent studies have demonstrated that suspension of the cervix to the sacrospinous ligament,
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