53: Prevalence of defecatory symptoms in patients with posterior vaginal wall defects on dynamic MRI

Abstract

This IRB-exempt study utilized unembalmed female human cadavers. Sacrohysteropexy was performed on 6 cadavers, by affixing polypropylene mesh posteriorly on the uterus/ vagina and anchoring it to the anterior longitudinal ligament overlying the S1 sacral vertebrae. A 9/16 to 3/4-inch diameter metal washer was placed above the midline uterine fundus and attached to a 6 inch long, 8/32 diameter bolt that was threaded through a small opening created at the uterine fundus, down the cervical canal, and out the vagina. The vaginal end of the bolt was fastened to a waxed surgical filament oriented parallel to the table and over a fixed pulley at the table's end. Successive weights of 0.5 to 4.0 kg (in 0.5 kg intervals) were added to provide increasing loads on the uterine fundus, and the distances traversed by the fundus were recorded. The same process was repeated after completion of a total hysterectomy (with vaginal cuff closure) and subsequent sacrocolpopexy with posterior mesh placement. Data were analyzed using ANOVA for within group comparisons. The mean distances traversed for each weight for the two procedures were compared using Student's t tests (Sigma Plot version 13.0), with P 0.05 considered statistically significant. RESULTS: The mean age of the cadavers was 75.3 years. Average BMI was 26.6 kg/m2. All specimens were white. Average distances (AE standard deviation) in cm pulled with 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 kg of traction against the uterine fundus after sacrohysteropexy were 0.7 (AE 0.3), 1.2 (AE 0.5), 1.7 (AE 0.5), 2.2 (AE 0.5), 2.6 (AE 0.6), 2.6 (AE 0.6), 2.9 (AE 0.8), and 3.0 (AE 0.7), respectively. After hysterectomy with sacrocolpopexy, these distances (cm) were 0.7 (AE 0.3), 1.0 (AE 0.4), 1.7 (AE 0.4), 1.8 (AE 0.4), 2.0 (AE 0.4), 2.5 (AE 0.4), 2.7 (AE 0.9), and 3.0 (AE 0.6), respectively. Figure 1 illustrates the distances traversed by the apex for these two procedures. There were no statistical differences in the distances moved between sacrohysteropexy and total hysterectomy/sacrocolpopexy. CONCLUSION: In this study, using each cadaver as its own control, there was no difference in the ability of the uterine fundus (after sacrohysteropexy) compared to the vaginal cuff (after sacrocolpopexy) to resist downward traction of successive weights up to 4 kg, as measured by the apical distance traveled. This suggests that functional support provided by these two procedures may be similar. Further studies are needed to correlate these findings with patient satisfaction, which may vary despite similar anatomic results.