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Prospective evaluation of paravaginal defect repair with and without apical suspension: a 6-month postoperative follow-up with MRI, clinical examination, and questionnaires

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Abstract

Introduction and hypothesis

Paravaginal defect (PVD) has been suggested as one of the main contributors to the development of prolapse in the anterior vaginal wall (AVW). We aimed to evaluate the descent of pelvic organs, presence of vaginal H configuration, and pubococcygeus (PC) muscle defect by pelvic magnetic resonance imaging (MRI), together with subjective symptoms of prolapse, before and 6 months after PVD repair. We also aimed to evaluate risk factors of recurrence.

Methods

Fifty women with PVD diagnosed by gynecological examination and scheduled for vaginal PVD repair were planned for enrollment. Preoperatively and 6 months postoperatively, subjective symptoms were evaluated using the International Consultation on Incontinence Questionnaire–Vaginal Symptoms (ICIQ-VS) together with MRI of the pelvis to evaluate defects in the PC muscle, vaginal shape, and pelvic organ descent.

Results

Forty-six women completed the study. Twenty had PVD repair alone, whereas 26 also had concomitant surgery performed. Prolapse grade, subjective symptoms, sexual problems, and quality of life (QoL) were significantly improved at follow-up. Missing vaginal H configuration was observed in 21 women before operation and was correlated with PC muscle defect. Recurrence rate was 39%, and significantly more women with recurrence had PC muscle defects and missing H configuration.

Conclusion

Vaginal PVD repair alone or combined with concomitant surgery significantly reduces objective prolapse and subjective symptoms. We could not demonstrate MRI findings of missing H configuration to be a sign of PVD but, rather, a sign of defect in the PC muscle. Risk of recurrence is significantly higher in women with major PC muscle defects and missing H configuration.

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Abbreviations

POP:

Pelvic organ prolapse

PVD:

Paravaginal defect

AVW:

Anterior vaginal wall

ATFP:

Arcus tendineus fascia pelvis

MRI:

Magnetic resonance imaging

POP-Q:

Pelvic Organ Prolapse Quantification System

ICIQ-VS:

International Consultation on Incontinence Questionnaire–Vaginal Symptoms

VSS:

Vaginal symptom score

SMS:

Sexual matter score

QoL:

Quality of life score

ICIQ-UI-SF:

International Consultation on Incontinence Questionnaire–Urinary Incontinence-Short Form

PC:

Pubococcygeus

PCL:

Pubococcygeal line

PGI-I:

Patient Global Impression of Improvement

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Authors and Affiliations

  1. Centre for Clinical Research, Department of Obstetrics and Gynaecology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark

    Louise T. S. Arenholt

  2. Center for Clinical Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Louise T. S. Arenholt

  3. Department of Radiology, Aarhus University Hospital, Aarhus, Denmark

    Bodil Ginnerup Pedersen

  4. Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark

    Karin Glavind

  5. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark

    Susanne Greisen, Karl M. Bek & Marianne Glavind-Kristensen

Authors
  1. Louise T. S. Arenholt
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  2. Bodil Ginnerup Pedersen
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  3. Karin Glavind
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  4. Susanne Greisen
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  6. Marianne Glavind-Kristensen
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Corresponding author

Correspondence to Louise T. S. Arenholt.

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Conflicts of interest

LTS Arenholt has received a speaker honorarium from BK Ultrasound and accepted travel grants from Astellas and Pierre-Fabre. BG Pedersen has no conflicts of interest. K Glavind, S Greisen, and M Glavind-Kristensen have accepted travel grants from Astellas. KM Bek has received speaker honorarium from BK Ultrasound.

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Arenholt, L.T.S., Pedersen, B.G., Glavind, K. et al. Prospective evaluation of paravaginal defect repair with and without apical suspension: a 6-month postoperative follow-up with MRI, clinical examination, and questionnaires. Int Urogynecol J 30, 1725–1733 (2019). https://doi.org/10.1007/s00192-018-3807-z

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  • DOI: https://doi.org/10.1007/s00192-018-3807-z

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