MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure

Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence.

This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health & Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30-42 months after surgery or prior to 30 months if undergoing reoperation for recurrence.

Of the 88 participants analyzed (aged 65 ± 7.7 years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, p = 0.14. Larger genital hiatus (H-line, 86.5 mm vs 72.3 mm, p = 0.003), low posterior position during strain (M-line, 55.6 mm vs 40.3 mm, p = 0.005), and apical compartments (vaginal apex position below pubococcygeal line (PCL), 42.1 mm vs 13.1 mm, p < 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3 mm vs 41.3 mm, p = 0.04), vaginal circumference (108.5 mm vs 96.1 mm, p = 0.03), and bladder descent vs successes.

Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.