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Analysis of long-term structural failure after native tissue prolapse surgery: a 3D stress MRI-based study


Introduction and hypothesis

We sought to identify postoperative structural failure sites associated with long-term prolapse recurrence and their association with symptoms and satisfaction.


Women who had a research MRI prior to native-tissue prolapse surgery were recruited for examination, 3D stress MRI, and questionnaires. Recurrence was defined by Pelvic Organ Prolapse Quantification System (POP-Q)Ba/Bp > 0 or C > -4. Measurements were performed at rest and maximum Valsalva (“strain”) including vaginal length, apex location, urogenital hiatus (UGH), and levator hiatus (LH). Measures were compared between subjects and to women with normal support. Failure frequency was the proportion of women with measurements outside the normal range. Symptoms and satisfaction were measured using validated questionnaires.


Thirty-one women participated 12.7 years after surgery—58% with long-term success and 42% with recurrence. Failure site comparisons between success and failure were: impaired mid-vaginal paravaginal support (62% vs. 28%, p = 0.01), longer vaginal length (54% vs. 22%, p = 0.03), and enlarged urogenital hiatus (54% vs. 22%, p = 0.03). Apical paravaginal location had the lowest failure frequency (recurrence: 15% vs. success: 7%, p = 0.37). Patient satisfaction was high (recurrence: 5.0 vs. success: 5.0, p = 0.86). Women with bothersome bulge symptoms had a 33% larger UGH strain on POP-Q (p = 0.01), 8.7% larger resting UGH (p = 0.046), 11.5% larger straining LH (p = 0.01), and 9.3% larger resting LH (p = 0.01).


Abnormal low mid-vaginal paravaginal location (Level II), long vaginal length (Level II), and large UGH (Level III) were associated with long-term prolapse recurrence. Patient satisfaction was high and unrelated to anatomical recurrence. Bothersome bulge symptoms were associated with hiatus enlargement.

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Investigator support was provided by National Institutes of Health (NIH) grant # R01 HD094954, R03 HD096189 and the National Institute of Child Health and Human Development (NICHD) WRHR Career Development Award #K12 HD065257. The NIH and NICHD played no role in the research design, data collection/analysis, decision to publish, or choice of journal for this manuscript.

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Correspondence to Luyun Chen.

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Table 2 Demographic and clinical data including POP-Q comparison of women with prolapse and normal controls
Table 3 Comparison of long-term follow-up mid-sagittal MRI measurements between women with success and recurrence

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Chen, L., Schmidt, P., DeLancey, J.O. et al. Analysis of long-term structural failure after native tissue prolapse surgery: a 3D stress MRI-based study. Int Urogynecol J (2021).

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  • Long-term follow-up
  • MRI
  • Native tissue prolapse surgery
  • Prolapse recurrence
  • Structure failure