Exploring pelvic organ prolapse surgery: insights from upright mri and the pelvic inclination correction system
Jaimy Simmering (TNW-M3i, ZGT-gynaecologie), Julia Eijsink (TNW-M3i, ZGT-gynaecologie), Annemarie van der Steen (TNW-M3i, ZGT-gynaecologie), Anique Bellos-Grob (TNW-M3i, ZGT-gynaecologie)
Abstract
Objectives:
Bladder descent is the most common type of pelvic organ prolapse (POP), causing complaints such as bulge feeling and urinary incontinence. However, the high recurrence rate up to 40% after bladder prolapse surgery is concerning, especially since the cause of this recurrence is poorly understood. We hypothesize that this knowledge gap is (partially) due to the lacking understanding of the true effect of bladder prolapse surgery, specifically in upright position.
Methods:
This prospective study included women with POP-Quantification (POP-Q) stage ≥2 bladder prolapse, in whom an anterior colporrhaphy was performed. Upright magnetic resonance imaging (MRI) in rest and physical examinations (POP-Q) were conducted preoperatively and 6 weeks postoperatively. On upright MRI the distance from the lowest point of the bladder to the Pelvic Inclination Correction System (PICS) line was measured. The Patient Global Impression of Improvement (PGI-I) questionnaire was completed 6 weeks postoperatively.
Results:
For the 59 included women, anatomical bladder lift ≥1 cm on upright MRI was observed in 75% of the patients. POP-Q stage improvement (physical examination) was observed in 90%. Symptomatic improvement (PGI-I) was reported by 93.2% of women.
Conclusion:
Nearly all patients experienced symptomatic and anatomical (physical examination) improvement 6 weeks after anterior colporrhaphy, while 25% does not reach 1 cm lift of the bladder on upright MRI. This supports the hypothesis that there is a lacking understanding of the true anatomical effect of bladder prolapse surgery. The long-term results at 1 and 2 years follow-up will provide additional insights in the recurrence-rates.