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3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects

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Abstract

Introduction and hypothesis

This study assesses relative contributions of "midline defects" (widening of the vagina) and "paravaginal defects" (separation of the lateral vagina from the pelvic sidewall).

Methods

Ten women with anterior predominant prolapse and ten with normal support underwent pelvic MR imaging. 3-D models of the anterior vaginal wall (AVW) were generated to determine locations of the lateral AVW margin, vaginal width, and apical position.

Results

The lateral AVW margin was farther from its normal position in cases than controls throughout most of the vaginal length, most pronounced midvagina (effect sizes, 2.2–2.8). Vaginal widths differed in the midvagina with an effect size of 1.0. Strong correlations between apical and paravaginal support were evident in mid- and upper vagina (r = 0.77–0.93).

Conclusions

Changes in lateral AVW location were considerably greater than changes in vaginal width in cases vs controls, both in number of sites affected and effect sizes. These "paravaginal defects" are highly correlated with apical descent.

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Acknowledgments

We gratefully acknowledge the support from the National Institute of Child Health and Human Development Grants R01 HD 38665 with additional investigator support from the Office for Research on Women’s Health SCOR on Sex and Gender Factors Affecting Women’s Health 1 P50 HD044406.

Conflicts of interest

Dr. John O.L DeLancey and Dr. James Ashton-Miller are consultants to American Medical Systems and Johnson and Johnson Personal Products. Jiajia Luo’s Ph.D. is partly funded by American Medical Systems. The other authors have no disclosures to report.

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Authors and Affiliations

  1. Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA

    Kindra A. Larson, Jiajia Luo, Kenneth E. Guire, Luyun Chen, James A. Ashton-Miller & John O. L. DeLancey

  2. Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    Kindra A. Larson & John O. L. DeLancey

  3. Departments of Mechanical and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    Jiajia Luo, Luyun Chen & James A. Ashton-Miller

  4. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Kenneth E. Guire

  5. 825 Fairfax Ave., Hofheimer Hall #310, Norfolk, VA, 23507, USA

    Kindra A. Larson

Authors
  1. Kindra A. Larson
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  2. Jiajia Luo
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  3. Kenneth E. Guire
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  4. Luyun Chen
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  5. James A. Ashton-Miller
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  6. John O. L. DeLancey
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Corresponding author

Correspondence to Kindra A. Larson.

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Larson, K.A., Luo, J., Guire, K.E. et al. 3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects. Int Urogynecol J 23, 285–293 (2012). https://doi.org/10.1007/s00192-011-1586-x

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  • DOI: https://doi.org/10.1007/s00192-011-1586-x

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