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Abstract

Background

Pelvic organ prolapse (POP) is a common disorder in elderly women often surgically repaired with alloplastic meshes; yet knowledge of the pelvic floor behavior and multi-compartment defects postoperatively is scarce.

Purpose

To evaluate the 1-year outcome after mesh repair in patients with POP using clinical examination (CE), dynamic magnetic resonance imaging (dMRI), and the prolapse quality-of-life (P-QOL) questionnaire.

Material and Methods

A prospective observational study was conducted of 69 women undergoing pelvic mesh surgery. Clinical examination, dMRI, and the P-QOL questionnaire were applied before and after surgery to evaluate POP. Mean outcome measures were POP outcome as determined on clinical and dMRI examinations and its impact on quality of life. Statistical results were obtained with SPSS version 15.0. ANOVA was used to compare pre-/postsurgical quality of life data.

Results

Sixty-nine women (mean age, 64.75 years; BMI, 26.75 kg/m²; postmenopausal, 89.2%) were recruited and treated with Seratom® or Perigee™ mesh implants. A significant improvement in the position of bladder neck, vaginal vault/uterus, pouch of Douglas, and rectum was found 12 weeks and 1 year after surgery using POP-Q scale and dMRI. Advanced cystoceles and enteroceles seem underestimated by CE using the POP-Q system compared to dMRI results (P = 0.003 and P < 0.001), vice versa dMRI overestimated POP compared to CE. Sixty-four women completed the P-QOL questionnaire, presenting reduced quality of life before surgery which improves postsurgically. Prolapse impact and physical, social, and role limitations correlated strongest with a low quality of life (P < 0.001).

Conclusion

The 1-year follow-up after mesh repair showed statistical and clinical improvement for all tools employed. dMRI seems a reliable tool for simultaneous assessment of defects in all three compartments, but tends to overestimate POP compared to clinical examination.

Keywords

Magnetic resonance imaging (MRI)pelvis urinary adults surgery

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References

Digesu

Khullar

Cardozo

. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16: 176–181. discussion 81.

Lenz

Stammer

Brocker

. Validation of a German version of the P-QOL Questionnaire. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 641–649.

Swift

Morris

McKinnie

. Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17: 615–620.

Sand

Koduri

Lobel

. Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 2001; 184: 1357–1362. discussion 62–64.

Boyles

Weber

Meyn

. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 2003; 188: 108–115.

DeLancey

. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 2005; 192: 1488–1495.

Olsen

Smith

Bergstrom

. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89: 501–506.

Whiteside

Weber

Meyn

. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 2004; 191: 1533–1538.

Gabriel

Farthmann

Brintrup

. Surgical repair of posterior compartment prolapse: preliminary results of a novel transvaginal procedure using a four-armed polypropylene mesh with infracoccygeal and pararectal suspension. Acta Obstet Gynecol Scand 2007; 86: 1236–1242.

10.

Boyadzhyan

Raman

Raz

. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics 2008; 28: 949–967.

11.

de Tayrac

Deffieux

Gervaise

. Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17: 483–488.

12.

Dietz

. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol 2004; 23: 80–92.

13.

Law

Fielding

. MRI of pelvic floor dysfunction: review. Am J Roentgenol 2008; 191: S45–S53.

14.

Betschart

Chen

Ashton-Miller

. On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic Inclination Correction System. Int Urogynecol J 2013; 24: 1421–1428.

15.

Bump

Mattiasson

. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175: 10–17.

16.

Yang

Mostwin

Rosenshein

. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 1991; 179: 25–33.

17.

Singh

Reid

Berger

. Translevator gluteal hernia. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12: 407–409.

18.

Gufler

DeGregorio

Dohnicht

. Dynamic MRI after surgical repair for pelvic organ prolapse. J Comput Assist Tomogr 2002; 26: 734–739.

19.

Broekhuis

Futterer

Barentsz

. A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 721–729.

20.

Mortele

Fairhurst

. Dynamic MR defecography of the posterior compartment: Indications, techniques and MRI features. Eur J Radiol 2007; 61: 462–472.

21.

El Sayed

El Mashed

Farag

. Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology 2008; 248: 518–530.

22.

Altman

Vayrynen

Engh

. Short-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19: 787–793.

23.

Digesu

Chaliha

Salvatore

. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 2005; 112: 971–976.

24.

Barber

Brubaker

Nygaard

. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 2009; 114: 600–609.

25.

Svihrova

Digesu

Svihra

. Validation of the Slovakian version of the P-QOL questionnaire. Int Urogynecol J 2010; 21: 53–61.

26.

Patel

Gillespie

Foxman

. Sexual behavior of older women: results of a random-digit-dialing survey of 2,000 women in the United States. Sex Transm Dis 2003; 30: 216–220.

27.

Rechberger

Skorupski

. The controversies regarding the role of estrogens in urogynecology. Folia Histochem Cytobiol 2007; 45(Suppl. 1): S17–S21.

One-year dynamic MRI follow-up after vaginal mesh repair: evaluation of clinical,radiological,and quality-of-life results

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

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References