E-Posters-10229

10229_Chen

Pdf Summary

The aim of this study was to assess the anatomical goals achieved in prolapse surgery using 3D stress MRI. The study found that the failure rate of prolapse surgery is high, with the anterior vaginal wall being the most common site of recurrence. The three supporting subsystems of the pelvic floor were identified as the vaginal wall, connective tissue attachment, and levator ani muscle and hiatal subsystems.<br /><br />The study developed a method to quantify the changes in pelvic support in all three subsystems at all three levels. Two hypotheses were tested and rejected. Firstly, it was found that prolapse surgery performed by board-certified subspecialist surgeons achieved better anatomical goals in level I and level II support than in level III support. Secondly, it was observed that apical improvement surgery corrected paravaginal support in level I and level II, and surgery to correct the hiatus correlated with paravaginal location improvement in level III.<br /><br />The results showed that 6 out of 7 subjects who underwent apical suspension/improvement surgery had an apex within the normal range post-operatively. However, despite attempts to reduce the hiatus through posterior repair, 5 out of 9 patients still had a larger than normal hiatus postoperatively.<br /><br />Improvement in apex strongly correlated with the reduction of upper paravaginal defect and correction of upper vaginal location (level I and level II), but did not improve distal vaginal support (level III). Reduction of the hiatus was related to improved distal anterior vaginal support.<br /><br />Overall, this study highlights the need to re-evaluate current surgical strategies for prolapse surgery and assess the achievement of anatomical goals. Further research is needed to understand the factors influencing surgical outcomes and improve the success rate of prolapse surgery.

Keywords

prolapse surgery

3D stress MRI

anatomical goals

failure rate

anterior vaginal wall

recurrence

supporting subsystems

pelvic floor

connective tissue attachment

levator ani muscle