Vaginal configuration on MRI after abdominal sacrocolpopexy and sacrospinous ligament suspension

An MRI study was conducted to compare the vaginal configuration of women who had undergone sacrospinous fixation with transvaginal needle suspension or abdominal sacrocolpopexy with retropubic colposuspension with that of normal controls. MRI examination demonstrated that in normal controls the lower vagina formed an acute angle (mean 53 degrees) with the pubococcygeal line and intersected the upper vagina at a mean angle of 145 degrees. In the abdominal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 57 degrees and joined the upper segment at a mean angle of 137 degrees. In the vaginal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 54 degrees and joined the upper segment at a mean angle of 220 degrees. Our study demonstrated that abdominal sacrocolpopexy with retropubic colposuspension more closely restored the vagina to its normal configuration, whereas sacrospinous fixation with transvaginal needle suspension creates an abnormal vaginal axis.