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Updated: Jun 23, 2026
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary
Luiz Carlos Santos Junior1, Luiz Gustavo Oliveira Brito1, Edilson Benedito de Castro1
1Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.
Objective:
Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse.
Methods:
In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05.
Results:
After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002).
Conclusion:
Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.
Insights
Magnetic resonance imaging (MRI) shows that larger levator ani subtended volumes (eLASV) are linked to surgical failure in pelvic-organ prolapse (POP) management. Both abdominal sacrocolpopexy and vaginal sacrospinous fixation demonstrated similar objective outcomes.
Area of Science:
- Urogynecology and Pelvic Reconstructive Surgery
- Medical Imaging and Diagnostics
- Surgical Outcomes Research
Background:
- Pelvic-organ prolapse (POP) management often involves surgical intervention.
- The role of Magnetic Resonance Imaging (MRI) in assessing POP and predicting surgical success remains under investigation.
- Standardized MRI metrics and their correlation with clinical outcomes require further elucidation.
Purpose of the Study:
- To compare the mid- to long-term results of two surgical techniques for apical POP: abdominal sacrocolpopexy (ASC) and bilateral vaginal sacrospinous fixation with anterior mesh (VSF-AM).
- To evaluate the association between specific MRI-derived measurements and surgical outcomes (objective and subjective cure).
- To determine the utility of MRI in assessing surgical success for pelvic-organ prolapse.
Main Methods:
- A randomized trial involving 40 women with apical POP comparing ASC (n=20) and VSF-AM (n=20).
- Preoperative and one-year postoperative assessments included physical examination (POP Quantification System - POP-Q) for objective cure and ICIQ-VS for subjective cure.
- One year post-surgery, MRI variables including pubococcigeous line (PCL), bladder base (BB), anorectal junction (ARJ), and estimated levator ani subtended volume (eLASV) were analyzed.
Main Results:
- After a mean 27-month follow-up, objective cure rates by MRI were 60% for VSF-AM and 45% for ASC (p=0.52).
- A significant correlation was observed between POP-Q staging and objective MRI cure rates for the anterior vaginal wall (p=0.007), but not with subjective cure.
- A larger eLASV (cutoff ≥ 33.5 mm³; ROC: 0.813; p=0.002) was significantly associated with postoperative surgical failure.
Conclusions:
- Both ASC and VSF-AM surgical techniques yielded comparable objective outcomes in terms of POP-Q measurements and MRI cure rates.
- Increased estimated levator ani subtended volume (eLASV) is a significant predictor of surgical failure in POP management.
- MRI parameters, particularly eLASV, may offer valuable insights into predicting surgical success in pelvic-organ prolapse treatment.
