Rane, Ajay, Lim, Yik Nyok, Withey, Grant, and Muller, Reinhold (2004) Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: a randomised study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 44 (2). pp. 135-139.

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Abstract

Objective: to compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP).

Materials and methods: twenty-one patients with vault prolapse requiring surgical treatment were randomly assigned in a balanced way to undergo SSF (n = 7), PIVS (n = 7) or SCP (n = 7). The magnetic resonance imaging of the pelvis were performed preoperatively and at 6–12 weeks postoperatively to assess the vaginal configuration using the method described previously. The two main angles measured were: (i) the angle between the lower vagina and pubococcygeal line 'd-angle' (normal: 53 ± 15°); and (ii) the angle between the lower and upper vagina planes 'e-angle' (normal: 145 ± 7°).

Results: the mean preoperative/postoperatively measured d-angles were 69°/62°, 58°/70°, and 49°/52° for SSF, PIVS and SCP, respectively. The corresponding means for the e-angle were 173°/215°, 189°/146°, and 205°/149°. The changes of the e-angles proved to be statistically significant (P < 0.05) in each surgical group, while no significant change in the d-angle could be found in any of the three groups.

Conclusions: significant improvements in the restoration of vaginal configuration were achieved in patients who underwent PIVS or SCP. Sacrospinous fixation in contrast seems to increase anatomical distortion of the vaginal configuration.

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