MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure
Year: 2026
Type: article
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.
Authors: Mark E. Lockhart, Pamela A. Moalli, Holly E. Richter, Isuzu Meyer, Allison C. Weidner, Yuko M. Komesu, Benjamin Carper, Marie G. Gantz, for the Eunice Kennedy Shriver NICHD Pelvic Floor Disorders Network, Kimberly Ferrante, Sherella Johnson, Emily S. Lukacz, Charles W. Nager, Gouri B. Diwadkar, Keisha Y. Dyer, Linda M. Mackinnon, Jasmine Tan-Kim, Gisselle Zazueta-Damian, Cindy Amundsen, Yasmeen Bruton, Notorious Coleman-Taylor, Amie Kawasaki, Nicole Longoria, Shantae McLean, Nazema Siddiqui, Alison Weidner, Kathy Carter, R. Edward Varner, David R. Ellington, Sunita Patel, Nancy Saxon, Velria B. Willis, Cassandra Carberry, B. Star Hampton, Nicole Korbly, Ann S. Meers, Deborah L. Myers, Charles R. Rardin, Vivian W. Sung, Kyle Wohlrab, Gena Dunivan, Peter Jeppson, Rebecca G. Rogers, Lily Arya, Lorraine Flick, Heidi Harvie, Michelle Kinglee, Ariana Smith, Steven D. Abramowitch, Michael Bonidie, Shaniel Bowen, Judy Gruss, Jonathan Shepherd, Gary Sutkin, Halina M. Zyczynski, Matthew Barber, Annette Graham, Marie Fidela R. Paraiso, Cecile Ferrando, Donna Mazloomdoost, Kate Burdekin, Michael Ham, Amanda Shaffer, Amaanti Sridhar, Dennis Wallace, Ryan Whitworth, Taylor Swankie
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,790
Funders: Andrew W. Mellon Foundation, Eli Lilly and Company, American Institute of Ultrasound in Medicine, Kaiser Permanente, Patient-Centered Outcomes Research Institute, RTI International, Dartmouth College, Boston Scientific Corporation, Coloplast, National Institutes of Health, University of California, San Diego, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Child Health and Human Development, Office of Research on Women's Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1059667558, G1967102714, G2516686185, G2540549055, G2602659566, G2625726820, G2876108733, G3268783860, G3479276667, G3635159340, G3966151781, G4157666827, G4354517318, G4361913982, G4547005390, G4574270551, G5126835330, Cleveland Clinic Clinical Site, G5418896253, G5993449061, G6346758217, G6618978875, G6694243416, G6728072733, Brown/WIH Pelvic Floor Disorders Network Site, G7364805660, G7658321000, G7914547723, G8168576316, G8384196886, G8563561067, G8884959188, G9000118490, G9000299673
OpenAlex ID: W7162875574