Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study

Area of Science:

• Urogynecology
• Pelvic Floor Surgery
• Medical Imaging

Background:

• Female genital apical prolapse significantly impacts quality of life.
• Laparoscopic lateral mesh suspension (LLMS) is a viable surgical option for apical prolapse.
• Limited data exists on vaginal axis changes after LLMS compared to other prolapse surgeries.

Purpose of the Study:

• To evaluate the anatomical correction achieved by LLMS.
• To compare the vaginal axis in patients undergoing LLMS with a nulliparous control group using MRI.
• To assess changes in the vaginal axis post-LLMS surgery.

Main Methods:

• Prospective observational case-control study including LLMS patients and nulliparous controls.
• Magnetic resonance imaging (MRI) performed pre- and post-operatively on both groups.
• Measurement of specific angles defining the vaginal axis and levator plate position.

Main Results:

• Significant improvement in vaginal axis angles (pubococcygeal line to lower vaginal segment, levator plate to pubococcygeal line) after LLMS (p < 0.001).
• Postoperative vaginal axis angles in LLMS patients were comparable to nulliparous controls.
• Significant reduction in Pelvic Organ Prolapse Symptom Score (POP-SS) post-surgery (p < 0.001).

Conclusions:

• LLMS effectively restores the vaginal axis to a near-normal position.
• The surgical technique provides anatomical correction comparable to healthy controls.
• LLMS improves symptoms and anatomical parameters in patients with apical genital prolapse.