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Preoperative level II/III MRI measures predicting long-term prolapse recurrence after native tissue repair

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A Correction to this article was published on 22 September 2022

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Abstract

Introduction and hypothesis

To identify preoperative level II/III MRI measures associated with long-term recurrence after native tissue prolapse repair.

Methods

Women who previously participated in pelvic floor research involving MRI prior to undergoing primary native tissue prolapse repair were recruited to return for repeat examination and MRI. Recurrence was defined by POP-Q (Ba/Bp > 0 or C > –4), repeat surgery, or pessary use. Preoperative MR images were used to perform five level II/III measurements including a new levator plate (LP) shape analysis at rest and maximal Valsalva. Principal component analysis (PCA) was used to evaluate LP shape variations. Principal component scores calculated for two independent shape variations were noted.

Results

Thirty-five women were included with a mean follow-up of 13.2 ± 3.3 years. Nineteen (54%) were in the success group. There were no statistical differences between success versus recurrence groups in demographic, clinical, or surgical characteristics. Women with recurrence had a larger preoperative resting levator hiatus [median 6.4 cm (IQR 5.7, 7.1) vs. 5.8 cm (IQR 5.3, 6.3), p = 0.03]. This measure was associated with increased odds of recurrence (OR 8.2, CI 1.4-48.9, p = 0.02). Using PCA, preoperative LP shape PC1 scores were different between success and recurrence groups (p = 0.02), with a more dorsally oriented LP shape associated with recurrence.

Conclusions

Larger preoperative levator hiatus at rest and a more dorsally oriented levator plate shape were associated with prolapse recurrence at long-term follow-up. For every 1 cm increase in preoperative resting levator hiatus, the odds of long-term prolapse recurrence increases 8-fold.

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Funding

CWS received research support from the National Institutes of Health, grants #R03 HD096189 and #K12 HD065257. LC received research support from the National Institute of Health, grant #R21 HD079908. The original studies from which the MRIs were obtained were funded by the National Institutes of Health, grants #R01 HD038665 and #R01 HD044406.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA

    Payton Schmidt, Luyun Chen, John O. DeLancey & Carolyn W. Swenson

  2. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA

    Luyun Chen

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  1. Payton Schmidt
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Contributions

P Schmidt: data collection or management, data analysis, manuscript writing/editing.

L Chen: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

JO DeLancey: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

CW Swenson: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

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Correspondence to Payton Schmidt.

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Appendix

Appendix

Table 2 Long-term follow up demographics and POP-Q measures in success versus recurrence groups
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Schmidt, P., Chen, L., DeLancey, J.O. et al. Preoperative level II/III MRI measures predicting long-term prolapse recurrence after native tissue repair. Int Urogynecol J 33, 133–141 (2022). https://doi.org/10.1007/s00192-021-04854-3

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