An MRI comparison of anatomical changes related to surgical treatment of prolapse by vaginal or abdominal route.
OBJECTIVE
The aim of this study was to determine whether or not abdominal or vaginal access is the best choice for treating genital prolapse in term of anatomical postoperative results, using an MRI pre and postoperative assessment.


METHODS
Prospective study was conducted on 43 consecutive patients planned for surgery for genital prolapse from October 2001 to February 2002. The patients were studied with dynamic and static MRI sequence 4 months after surgery to indicate surgical effects on organ position. The position was evaluated with respect to the pubo coccygeal line in a dynamic sequence.


RESULTS
Fifteen patients had their prolapse corrected by laparotomy always associated with sub-total hysterectomy, anterior and posterior prosthetic mesh with promontory fixation to the prevertebral ligament. Sixteen others were subjected to vaginal route with vaginal hysterectomy, paravaginal suspension followed in all cases by suspension of the vaginal cuff using Richter's technique and myorraphy of the levators. Finally, 12 patients benefited from a suspension of a sacrospinous suspension and myorraphy of the levators, without paravaginal suspension. Measure of the MRI organ location showed no significant difference except for bladder position in vaginally operated women (P = 0.02). Vaginal length and axis were comparable in all groups.


CONCLUSIONS
Our study confirmed the objective effectiveness of the anatomical prolapse corrections conducted by abdominal route using sacropexy or by vaginal route using sacrospinous fixation. The correction provided by vaginal route always results in a return of the bladder and the vaginal fundus to their normal positions, which clearly demonstrates the short-term effectiveness of these surgical suspensions. Prolapse corrections by vaginal route did not result in any shortening of the vagina or postoperative change in vaginal orientation. Further evaluations will be needed to assess the long-term results.
Boukerrou A
Malik
M
Pôle de chirurgie gynécologique, Hopital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
Mesdagh B
Philippe
P
Ego A
Anne
A
Lambaudie A
Eric
E
Crepin A
Gilles
G
Robert B
Yann
Y
Cosson A
Michel
M
D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011184:Postoperative Period; D012007:Rectum / Q000033:anatomy & histology; D001743:Urinary Bladder / Q000033:anatomy & histology; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus / Q000033:anatomy & histology; D014621:Vagina / Q000033:anatomy & histology