title: Does bilateral sacrospinous fixation with synthetic mesh recreate nulliparous pelvic anatomy? An MRI evaluation.
abstract: OBJECTIVE
  The aim of this study was to determine whether the bilateral sacrospinous vault fixation (BSSVF) with synthetic, polypropylene mesh arms restores the nulliparous anatomic relationships of the vaginal vault in women with and without uterus using magnetic resonance imaging (MRI).
  
  
  METHODS
  This was a prospective case series of women with symptomatic pelvic organ prolapse (POP) who, after BSSVF, underwent a pelvic MRI (1-13 months postoperatively). Postsurgical pelvic distances were measured from MRI scans and compared with measurements from a group of 11 nulliparous women with adequate pelvic support who underwent MRI in a previous study. Our primary outcome measure was the difference in average distance from the vault to the ischial spine among women after BSSVF when compared with the average nulliparous distances. The secondary outcome measures were the difference in average distance from the posterior fornix to the sacrum and the change in apical POP quantification parameters 6 weeks after surgery.
  
  
  RESULTS
  Ten women underwent MRI post-BSSVF-4 women with and 6 women without uterine preservation. In the BSSVF group, similar to the nulliparous group measurements, the average distance between the vaginal apex and the spine was 5.2 cm (SD, 0.8) (95% confidence interval, -0.6 to 0.5; P = 0.92). There was an anterior-inferior displacement of the line between the vaginal apex and the sacrum in women who underwent BSSVF. The posterior fornix was 7.4 cm (SD, 1.2) from the second sacral vertebra versus 5.6 cm (SD, 1.5) in women without POP (P < 0.01). Adequate clinical resolution of apical prolapse was confirmed in all women 6 weeks post-BSSVF.
  
  
  CONCLUSIONS
  The BSSVF with synthetic mesh restores the anatomy between the vagina and the ischial spines. Clinical studies are underway to compare BSSVF with standard techniques of vaginal vault prolapse repair.
authors: From the University of British Columbia, Vancouver, British Columbia, Canada.
authors: Vanessa
authors: V
authors: Nicolau-Toulouse
authors: Pari
authors: P
authors: Tiwari
authors: Terry
authors: T
authors: Lee
authors: Geoffrey William
authors: GW
authors: Cundiff
authors: Roxana
authors: R
authors: Geoffrion
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017773:Pelvic Floor / Q000033:anatomy & histology* / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011126:Polypropylenes / Q000627:therapeutic use; D011446:Prospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014621:Vagina / Q000033:anatomy & histology* / Q000601:surgery
chemical_list: D011126:Polypropylenes