MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure

INTRODUCTION AND HYPOTHESIS: Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence. METHODS: This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health & Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30-42 months after surgery or prior to 30 months if undergoing reoperation for recurrence. RESULTS: Of the 88 participants analyzed (aged 65 ± 7.7 years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, p = 0.14. Larger genital hiatus (H-line, 86.5 mm vs 72.3 mm, p = 0.003), low posterior position during strain (M-line, 55.6 mm vs 40.3 mm, p = 0.005), and apical compartments (vaginal apex position below pubococcygeal line (PCL), 42.1 mm vs 13.1 mm, p < 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3 mm vs 41.3 mm, p = 0.04), vaginal circumference (108.5 mm vs 96.1 mm, p = 0.03), and bladder descent vs successes. CONCLUSIONS: Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.

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Journal
International Urogynecology Journal
Published
2026-05-30
DOI
https://doi.org/10.1007/s00192-026-06699-0
Primary Topic
Pelvic floor disorders treatments
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article
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article

MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure

Gisselle Zazueta‐Damian, V. N. B. Willis, Gary Sutkin, Sherella Johnson et al.
International Urogynecology Journal
Pelvic floor disorders treatments
article

MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure

Gisselle Zazueta‐Damian, V. N. B. Willis, Gary Sutkin, Sherella Johnson, Charles R. Rardin, Shantae McLean, Jasmine Tan-Kim, Amanda Shaffer, Nicole Longoria, Annette Graham, Linda M. Mackinnon, Marie Fidela R. Paraiso, Halina M. Zyczynski, Notorious Coleman-Taylor, Gouri B. Diwadkar, Sunita Patel, Steven D. Abramowitch, Amie Kawasaki, Ariana Smith, Charles W. Nager, Yuko M. Komesu, Taylor Swankie, Nancy Saxon, J. Shepherd, Judy Gruss, Kate Burdekin, Ann S. Meers, Facog Gena Dunivan, Amaanti Sridhar, Marie G. Gantz, Mark E. Lockhart, D. Mazloomdoost, Keisha Y. Dyer, Deborah L. Myers, Isuzu Meyer, Rebecca G. Rogers, B. Star Hampton, R. Edward Varner, Michelle Kinglee, Emily S. Lukacz, Pamela A. Moalli, Heidi Harvie, Lily Arya, Shaniel Bowen, Alison Weidner, Nazema Siddiqui, Lorraine Flick, for the Eunice Kennedy Shriver NICHD Pelvic Floor Disorders Network, David R. Ellington, Cindy Amundsen, Peter Jeppson, Kimberly Ferrante, Nicole Korbly, Cassandra Carberry, Ryan Whitworth, Michael Bonidie, Holly E. Richter, Allison C. Weidner, Yasmeen Bruton, Benjamin Carper, Kyle Wohlrab, Cecile Ferrando, Matthew Barber, Dennis Wallace, Michael Ham, Kathy Carter, Vivian W. Sung
article en

Abstract

INTRODUCTION AND HYPOTHESIS: Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence. METHODS: This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health & Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30-42 months after surgery or prior to 30 months if undergoing reoperation for recurrence. RESULTS: Of the 88 participants analyzed (aged 65 ± 7.7 years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, p = 0.14. Larger genital hiatus (H-line, 86.5 mm vs 72.3 mm, p = 0.003), low posterior position during strain (M-line, 55.6 mm vs 40.3 mm, p = 0.005), and apical compartments (vaginal apex position below pubococcygeal line (PCL), 42.1 mm vs 13.1 mm, p < 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3 mm vs 41.3 mm, p = 0.04), vaginal circumference (108.5 mm vs 96.1 mm, p = 0.03), and bladder descent vs successes. CONCLUSIONS: Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.

International Urogynecology Journal
University of Alabama at Birmingham Hospital (US), University of New Mexico (US), University of Pittsburgh (US), Duke University (US), RTI International (US), University of Alabama at Birmingham (US), Institute for Female Pelvic Medicine and Reconstructive Surgery (US)
National Institute of Child Health and Human Development
Good health and well-being
Openalex Percentile: Top 5%
Pelvic floor disorders treatments
DOIOpen Access PDFOpenAlex
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