Vaginal Configuration on MRI after Abdominal Sacrocolpopexy and Sacrospinous Ligament Suspension

Abstract

An MRI study was conducted to compare the vaginal configuration of women who had undergone sacrospinous fixation with transvaginal needle suspension or abdominal sacrocolpopexy with retropubic colposuspension with that of normal controls. MRI examination demonstrated that in normal controls the lower vagina formed an acute angle (mean 53 degrees) with the pubococcygeal line and intersected the upper vagina at a mean angle of 145 degrees. In the abdominal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 57 degrees and joined the upper segment at a mean angle of 137 degrees. In the vaginal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 54 degrees and joined the upper segment at a mean angle of 220 degrees. Our study demonstrated that abdominal sacrocolpopexy with retropubic colposuspension more closely restored the vagina to its normal configuration, whereas sacrospinous fixation with transvaginal needle suspension creates an abnormal vaginal axis.

Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

“…[12][13][14] During our preparatory dissections, we observed that the S4 foramen, which is found on the lowest border of the S4 vertebra, was more accurately and consistently identified in cadavers than the tip of the coccyx; therefore, we chose the S4 foramen instead of the coccyx in an attempt to increase reproducibility of our measurements. The vaginal axis angle was then measured from the PS-S4 line to each to each vertebral point and recorded using a 15 cm orthopedic goniometer (Quint Measuring Systems, Inc., San Ramon, CA) ( Figure 2).…”

The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse

“…Because it has proven its efficacy in vaginal vault prolapse surgery, it might be of interest to use it as a primary technique to correct descensus uteri, the so-called sacrospinous hysteropexy. The anatomical outcome and complication rate of this operation was described in few reports, but most authors do not focus on urogenital symptoms and quality of life after sacrospinous hysteropexy [3][4][5][6][7][8]. In a previous study by our group, we concluded that the sacrospinous hysteropexy is a promising technique for the correction of descensus uteri [9].…”

Bilateral sacrospinous fixation without hysterectomy: 18-month follow-up

“…The anatomic restoration is profoundly important in pelvic reconstructive surgery. MRI studies showed that ASC produces a vaginal axis closer to the original anatomic position than SSF (34).…”

“…Unilateral SSF appears satisfactory, with a low recurrence rate, but is associated with the anatomical distortion of the vagina and the rectum that may alter both sexuality and bowel function (11,14). Furthermore, some authors hypothesize that the higher POP recurrence and dyspareunia rates after unilateral SSF may be due to a posterior deviation of the vaginal axis and a tensioned repair with surgeons using permanent sutures during a unilateral SSF (15,16). Because of these reasons, some authors recommend bilateral SSF, and a few studies including small number of patients have focused on anatomical and functional results after bilateral SSF (17-21).…”