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Variations in structural support site failure patterns by prolapse size on stress 3D MRI

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Abstract

Introduction and Hypothesis

Our objective was to develop a standardized measurement system to evaluate structural support site failures among women with anterior vaginal wall-predominant prolapse according to increasing prolapse size using stress three-dimensional (3D) magnetic resonance imaging (MRI).

Methods

Ninety-one women with anterior vaginal wall-predominant prolapse and uterus in situ who had undergone research stress 3D MRI were included for analysis. The vaginal wall length and width, apex and paravaginal locations, urogenital hiatus diameter, and prolapse size were measured at maximal Valsalva on MRI. Subject measurements were compared to established measurements in 30 normal controls without prolapse using a standardized z-score measurement system. A z-score greater than 1.28, or the 90th percentile in controls, was considered abnormal. The frequency and severity of structural support site failure was analyzed based on tertiles of prolapse size.

Results

Substantial variability in support site failure pattern and severity was identified, even between women with the same stage and similar size prolapse. Overall, the most common failed support sites were straining hiatal diameter (91%) and paravaginal location (92%), followed by apical location (82%). Impairment severity z-score was highest for hiatal diameter (3.56) and lowest for vaginal width (1.40). An increase in impairment severity z-score was observed with increasing prolapse size among all support sites across all three prolapse size tertiles (p < 0.01 for all).

Conclusions

We identified substantial variation in support site failure patterns among women with different degrees of anterior vaginal wall prolapse using a novel standardized framework that quantifies the number, severity, and location of structural support site failures.

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Acknowledgements

The authors thank Sarah Block for assistance in preparing the manuscript.

Funding

Supported by National Institutes of Health (NIH) the Eunice Kennedy Shriver National Institute of Child Health and Human Development R01 HD094954, R01 HD038665 and ORWH grant P50 HD044406.

Author information

Authors and Affiliations

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

    Christopher X. Hong, John O. Delancey & Luyun Chen

  2. University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA

    Lahari Nandikanti & Beth Shrosbree

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

    Luyun Chen

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  1. Christopher X. Hong
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  5. Luyun Chen
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Contributions

CX Hong: Project development, data analysis, manuscript writing

L Nandikanti: Data collection

B Shrosbree: Data analysis

JO DeLancey: Project development, data analysis, manuscript writing

L Chen: Project development, data analysis, manuscript writing

Corresponding author

Correspondence to Christopher X. Hong.

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Conflict of interest

C.X.H. is an advisor/consultant for Cosm Medical, Toronto, ON, Canada. All other authors declare no conflicts of interest.

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Study conducted in Ann Arbor, MI

Presentation

This study was accepted for oral presentation at the American Urogynecologic Society/International Urogynecology Association Joint Scientific Meeting, June 14-18 2022, Austin, TX

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Hong, C.X., Nandikanti, L., Shrosbree, B. et al. Variations in structural support site failure patterns by prolapse size on stress 3D MRI. Int Urogynecol J 34, 1923–1931 (2023). https://doi.org/10.1007/s00192-023-05482-9

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  • DOI: https://doi.org/10.1007/s00192-023-05482-9

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