Vaginal axis on MRI after laparoscopic pectopexy surgery: a controlled study

Year 2024, Volume: 5 Issue: 5, 219 - 225, 26.10.2024

Fatih Şahin , Recep Yılmaz Bayraktarlı , Ozan Doğan

Abstract

Aims: Laparoscopic pectopexy has emerged as a feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several previous studies have reported changes in the vaginal axis in women who have undergone SCP, laparoscopic lateral mesh suspension, sacrospinous ligament fixation surgery for prolapse, there is a lack of data on changes in the vaginal axis after pectopexy. This study aimed to evaluate the degree of anatomical correction achieved by laparoscopic pectopexy in patients with apical genital prolapse using magnetic resonance imaging (MRI).
Methods: Individuals who experienced pectopexy and a nulliparous control group were enrolled in this prospective observational case-control investigation. MRI scans were conducted on both the control cohort and the study group before and after the procedure. The angles formed by the pubococcygeal line and the inferior vaginal segment, the levator plate and the pubococcygeal line, as well as the inferior and superior vaginal segments, were measured and compared.
Results: The change in angle between the lower vagina and upper vagina was statistically significant, with preoperative and postoperative values of 134.91°±6.25° and 166.82°±6.15°, respectively (p=0.0001). The angle between the lower vagina and pubococcygeal line showed a significant change, with preoperative and postoperative values of 44.64°±1.8° and 65.73°±10.19°, respectively (p=0.0001). Postoperative angles were not similar among nulliparous patients based on the MRI findings. The postoperative Urogenital Distress Inventory scores are significantly lower than the preoperative scores (p=0.0001).
Conclusion: The pectopexy procedure is not optimal for achieving a normal vaginal axis.

Keywords

Apical prolapse, pelvic organ prolapse, pectopexy, laparoscopic lateral mesh suspension, sacrospinous ligament fixation (SSLF)

Ethical Statement

The study was carried out with the permission of Ethical Committe of Faculty of İstanbul Prof. Dr. Cemil Taşçıoğlu Şehir hastanesi (Date: 28.06.2022 no: 351) All procedures were carried out in accordance with the ethical rules and the principles of the Declaration of Helsinki.

Supporting Institution

NONE

Project Number

351

Thanks

We would like to thank our referees for evaluating our article.

Laparoskopik pektopeksi ameliyatı sonrası MR'da vajinal eksen: kontrollü bir çalışma

Abstract

Amaçlar: Laparoskopik pektopeksi, kadın genital apikal prolapsusunu tedavi etmek için sakrokolpopeksiye (SCP) uygulanabilir bir alternatif olarak ortaya çıkmıştır. Birkaç önceki çalışmada SCP, laparoskopik lateral mesh süspansiyonu, prolapsus için sakrospinöz ligament fiksasyon ameliyatı geçiren kadınlarda vajinal eksende değişiklikler bildirilmiş olsa da, pektopeksi sonrası vajinal eksende değişiklikler hakkında veri eksikliği vardır. Bu çalışmanın amacı, manyetik rezonans görüntüleme (MRI) kullanılarak apikal genital prolapsusu olan hastalarda laparoskopik pektopeksi ile elde edilen anatomik düzeltme derecesini değerlendirmekti.
Yöntemler: Pektopeksi geçiren bireyler ve doğum yapmamış bir kontrol grubu bu prospektif gözlemsel vaka-kontrol araştırmasına dahil edildi. İşlemden önce ve sonra hem kontrol kohortunda hem de çalışma grubunda MRI taramaları yapıldı. Pubokoksigeal çizgi ve alt vajinal segment, levator plakası ve pubokoksigeal çizgi ile alt ve üst vajinal segmentlerin oluşturduğu açılar ölçüldü ve karşılaştırıldı.
Bulgular: Alt vajina ile üst vajina arasındaki açı değişimi istatistiksel olarak anlamlıydı, ameliyat öncesi ve sonrası değerler sırasıyla 134,91° ± 6,25° ve 166,82° ± 6,15° idi (p = 0,0001). Alt vajina ile pubokoksigeal çizgi arasındaki açı anlamlı bir değişim gösterdi, ameliyat öncesi ve sonrası değerler sırasıyla 44,64° ± 1,8° ve 65,73° ± 10,19° idi (p = 0,0001). Postoperatif açılar, MRI bulgularına göre nullipar hastalarda benzer değildi. Ameliyat sonrası Ürogenital Distres Envanteri skorları ameliyat öncesi skorlara göre anlamlı derecede düşüktür (p = 0,0001).
Sonuç: Pektopeksi prosedürü normal bir vajinal eksen elde etmek için ideal değildir.

Keywords

Apikal prolapsus, pelvik organ prolapsusu, pektopeksi, laparoskopik lateral mesh süspansiyonu, sakrospinöz ligament fiksasyonu (SSLF)

Project Number

351

References

• Wilkins MF, Wu JM. Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse. Minerva Ginecol. 2017;69 (2):171–177.
• DeLancey JOL. Surgery for cystocele III: do all cystoceles involve apical descent: observations on cause and effect. Int Urogynecol J. 2012;23(6):665–667.
• Funt MI, Thompson JD, Birch H. Normal vaginal axis. South Med J. 1978;71(12):1534–1535; 1552.
• Fatih Şahin, Ramazan Adan. Comparison of anterior and posterior approach bilateral sacrospinous ligament fixation for vaginal vault prolapse. Clin Exp Obstet Gynecol. 2023;50(10):216.
• Paraiso MFR, Ballard LA, Walters MD, Lee JC, Mitchinson AR, Shull B. Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol. 1996;175(6):1423-1430; discussion 1430–1.
• Cosson M, Boukerrou M, Lacaze S, et al. study of pelvic ligament strength. Eur J Obstet Gynecol Reprod Biol. 2003;109(1):80–87.
• Noé KG, Schiermeier S, Alkatout I, Anapolski M. Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy—postoperative results and intermediate-term follow-up in a pilot study. J Endourol. 2015;29(2):210–215.
• Diaz DC, Robinson D, Bosch R, et al. Patient-reported outcome assessment. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence, vol. 1. 6th ed. Tokyo: ICUD ICS; 2017. p. 541–670.
• Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the as_sessment of female sexual function. J Sex Marital Ther. 2000; 26(2):191-205.
• Sze EHM, Meranus J, Kohli N, Miklos JR, Karram MM. Vaginal configuration on MRI after abdominal sacrocolpopexy and sacrospinous ligament suspension. Int Urogynecol J. 2001;12(6): 375–380.
• Sato H, Abe H, Ikeda A, Miyagawa T, Sato K. Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse. J Obstet Gynaecol. 2021;41(1):128-132.
• Pulatoğlu Ç, Yassa M, Turan G, Türkyılmaz D, Doğan O. Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study. Int Urogynecol J. 2021;32(4):851-858.
• Dällenbach P. Laparoscopic Lateral Suspension (LLS) for the treatment of apical prolapse: a new gold standard? Front Surg. 2022;12;9:898392.
• Juliato CRT, Santos-Junior LC, de Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation-a randomized trial. Neurourol Urodyn. 2019;38(4):1142-1151.
• Li S, Wen X, Gao Z, et al. Comparison of the axes and positions of the uterus and vagina between women with and without pelvic floor organ prolapse. Front Surg. 2022;9:760723.
• Luo J, Betschart C, Ashton-Miller JA, DeLancey JO. Quantitative analyses of variability in normal vaginal shape and dimension on MR images. Int Urogynecol J. 2016; 27(7):1087-1095.
• Giraudet G, Protat A, Cosson M. The anatomy of the sacral promontory: how to avoid complications of the sacrocolpopexy procedure. Am J Obstet Gynecol. 2018; 218(4): 457.e1–457.e3.
• Mahoney C, Scott G, Dwyer L, et al. Laparoscopic sacrocolpopexy posthysterectomy: intraoperative feasibility and safety in obese women compared with women of normal weight. Int Urogynecol J. 2019;30(12):2041–2048.
• Hefni MA, El-Toukhy TA. Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse. Eur J Obstet Gynecol Reprod Biol. 2006; 127:257–263.
• El Hamamsy D, Fayyad AM. New onset stress urinary incontinence following laparoscopic sacrocolpopexy and its relation to anatomical outcomes. Int Urogynecol J. 2015;26(7): 1041-1045.
• Nichols DH, Milley PS, Randall CL. Significance of restoration of normal vaginal depth and axis. Obstet Gynecol. 1970;36(2):251–256.
• Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol. 2020;17(7):373-390.