Methods for the defining mechanisms of anterior vaginal wall descent (DEMAND) study

Moalli, Pamela; Bowen, Shaniel T.; Abramowitch, Steven D.; Lockhart, Mark E.; Ham, Michael; Hahn, Michael; Weidner, Alison C.; Richter, Holly E.; Rardin, Charles R.; Komesu, Yuko M.; Harvie, Heidi; Ridgeway, Beri; Mazloomdoost, Donna; Shaffer, Amanda; Gantz, Marie G.

doi:10.1007/s00192-020-04511-1

Cited by 5 publications

(6 citation statements)

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“…Detailed study protocol and 3-year outcomes for both studies have been published. [10][11][12][13] Institutional review board approval and participants' written informed consent were obtained at all study sites. Participants and the public…”

Section: Methodsmentioning

confidence: 99%

“…DEMAND and SUPeR were performed through the Pelvic Floor Disorders Network. Detailed study protocol and 3‐year outcomes for both studies have been published 10–13 . Institutional review board approval and participants' written informed consent were obtained at all study sites.…”

Section: Methodsmentioning

confidence: 99%

“…A subset of 88 DEMAND participants underwent pelvic MRI between June 2014 and May 2018. DEMAND inclusion and exclusion criteria were published 12 . Additional exclusion criteria were failure to capture the full vagina, poor demarcation of the vaginal borders, incomplete MRI and MRI taken after reoperation.…”

Section: Methodsmentioning

confidence: 99%

“…DEMAND inclusion and exclusion criteria were published. 12 Additional exclusion criteria were failure to capture the full vagina, poor demarcation of the vaginal borders, incomplete MRI and MRI taken after reoperation. Patient characteristics-demographics, medical history and Pelvic Organ Prolapse Quantification (POP-Q) measurements-from SUPeR 11 -were obtained at baseline (preoperative) and follow up (i.e., SUPeR study visit date closest to MRI examination date).…”

Section: Study Populationmentioning

confidence: 99%

“…The MRI methods have been reported elsewhere. 12 Briefly, participants were trained to perform maximal straining over six to eight visits before the MRI examination. Supine, multi-planar, T2-weighted images were collected with a 3T system and a pelvic phased array coil at rest (with prolapse fully reduced), maximal strain (maximum rest-to-strain vaginal descent out of three or four attempts) and recovery (rest period following strain without prolapse reduced).…”

Section: Mri Protocolmentioning

confidence: 99%

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Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Bowen

Moalli

Abramowitch

et al. 2023

BJOG

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ObjectiveTo identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.DesignSecondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross‐sectional study.SettingEight clinical sites in the US Pelvic Floor Disorders Network.Population or SampleWomen who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015.MethodsThe MRI (rest, strain) obtained 30–42 months after surgery, or earlier for participants with recurrence who desired reoperation before 30 months, were analysed. MRI‐based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three‐dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position.Main outcome measuresVaginal angulation (upper, lower and upper–lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume) and position (apex, mid‐vagina) at rest.ResultsOf the 82 women analysed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (p = 0.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (p = 0.01) and mid‐vagina (p = 0.01) at rest than women with successful surgery.ConclusionsVaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Mri Protocolmentioning

confidence: 99%

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