Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI

Abstract

The objective of the study was to determine the relationship between midsagittal vaginal wall geometric parameters and the degree of anterior vaginal prolapse. We have previously presented data indicating that about half of anterior wall descent can be explained by the degree of apical descent present (Summers et al., Am J Obstet Gynecol, 194:1438−1443, 2006. This led us to examine whether other midsagittal vaginal geometric parameters are associated with anterior wall descent. Magnetic resonance (MR) scans of 145 women from the prior study were suitable for analysis after eight were excluded because of inadequate visibility of the anterior vaginal wall. Subjects had been selected from a study of pelvic organ prolapse that included women with and without prolapse. All patients underwent supine dynamic MR scans in the midsagittal plane. Anterior vaginal wall length, location of distal vaginal wall point, and the area under the midsagittal profile of the anterior vaginal wall were measured during maximal Valsalva. A linear regression model was used to examine how much of the variance in cystocele size could be explained by these vaginal parameters. When both apical descent and vaginal length were considered in the linear regression model, 77% (R 2 =0.77, p<0.001) of the variation in anterior wall descent was explained. Distal vaginal point and a measure anterior wall shape, the area under the profile of the anterior vaginal wall, added little to the model. Increasing vaginal length was positively correlated with greater degrees of anterior vaginal prolapse during maximal Valsalva (R 2 =0.30, p<0.01) determining 30% of the variation in anterior wall decent. Greater degrees of anterior vaginal prolapse are associated with a longer vaginal wall. Linear regression modeling suggests that 77% of anterior wall descent can be explained by apical descent and midsagittal anterior vaginal wall length.

The Long and Short of it: Anterior Vaginal Wall Length before and after Anterior Repair

“…In all women, AVL was reduced after surgery and on average, AVL was shortened by 2.5 cm. Mean postoperative AVL was 6.4± 0.8 cm, similar to the mean AVL in women with normal pelvic support (6.1±1.3 cm, p=0.15) [5]. Women with longer preoperative AVLs underwent greater change in AVL (2.9 vs 1.4 cm, p=0.005; R 2 =0.78, p=<0.0001; Table 2).…”

“…Hsu et al showed that although apical descent is the primary factor contributing to cystocele size, increasing vaginal length accounted for 30 % of anterior wall prolapse. Re-analysis of Hsu's data found that the AVL is 23 % longer in women with cystocele than in normal controls (7.4±1.7 cm vs 6.1±1.3 cm) [5].…”

Thirty Years of Cystocele/Rectocele Repair in the United States

“…All United States regions, hospital types, and hospital sizes were represented in the population (Table 3). 7 The database contained a total of 6,499,132 diagnosed cases of cystocele/rectocele, apical defect, or cystocele/rectocele plus apical defect. Of those diagnosed cases, There was a significant decrease in the frequency of isolated cystocele/rectocele repair procedures performed between 1979 (96.3%, n=150,980) and 2009 (67.7%, n=61,444).…”

“…(4,5) The literature over the last 15 years advocates for a change in practice patterns, encouraging surgeons to not only recognize the role of apical defects in pelvic organ prolapse, but to also perform concomitant procedures addressing those defects. (5)(6)(7)(8)(9) In 2010 Jones and colleagues 5 used the National Hospital Discharge Survey to describe a decrease in age-adjusted rates of inpatient prolapse procedures from 1979 to 2006, especially in patients less than 52 years of age. Interestingly, a secondary outcome of their study showed an increase in apical suspension procedures in patients greater than 52 years of age suggesting that practice patterns were reflecting the movement in favor of apical support.…”

A retrospective comparison of two vaginal mesh kits in the management of anterior and apical vaginal prolapse: long-term results for apical fixation and quality of life

“…Summers et al showed that level-I defects contribute to the onset of cystocele, and suggested that levels I and II should be treated together to achieve efficient anterior compartment repair [18]. Yousuf et al and Hsu et al, comparing cystocele graded on POP-Q and anatomic lesions assessed on MRI, found a correlation between high-grade cystocele on MRI and cervical ring defects [19,20].…”