Original Article

Ultrasound-Measured Urethral Length Does Not Change following Minimally Invasive Sacrocolpopexy for Pelvic Organ Prolapse

Authors: Maeve A. Serino, BA, Sarah A. Collins, MD, Kimberly Kenton, MD, MS, Julia Geynisman-Tan, MD

Abstract

Objectives: To compare urethral length (UL), as measured by three-dimenstional transvaginal ultrasound, before and after minimally invasive sacrocolpopexy (SCP).

Methods: Secondary analysis of a prospective cohort study of women undergoing SCP for prolapse beyond the hymen with or without a concomitant anti-incontinence procedure. Participants underwent ultrasound at baseline and 14 weeks postoperatively. UL was measured in a reconstructed sagittal plane from the bladder neck to the urethral meatus. All of the participants underwent multichannel urodynamics preoperatively. Data were analyzed in SPSS using independent or paired t tests as indicated for continuous variables and the McNemar test for paired dichotomous variables. Correlations including nonparametric data are reported as Spearman rho.

Results: A total of 28 participants, with a mean ± standard deviation age of 56 ± 10 years and median (interquartile range) preoperative prolapse stage of 3 (3–3), were analyzed. There was no change in UL between the baseline and 14-week visits (29.8 ± 11.0 mm vs 29.3 ± 10.0 mm, P = 0.83). There was no difference in baseline UL (29.4 ± 11.8 mm vs 30.9 ± 8.9 mm, P = 0.74) in those with and without preoperative stress urinary incontinence (SUI), nor was there a difference in baseline functional UL on multichannel urodynamics between these groups. In total, 21 participants (75%) had preoperative SUI and 19 (90%) underwent a concomitant anti-incontinence procedure. UL at 14 weeks was similar in those with and without SUI symptoms (26.5 ± 10.9 mm vs 31.1 ± 11.3 mm, P = 0.32) when controlling for those who underwent anti-incontinence procedures.

Conclusion: UL does not change following suspension of the anterior vaginal wall with SCP.
Posted in: Obstetrics and Gynecology77

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Hsu Y, Chen L, Summers A, et al. Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:137–142.
 
2. Bai SW, Jeon MJ, Kim JY, et al. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J 2002;13:256–260.
 
3. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 1994;170: 1713–1720.
 
4. Swift S, Woodman P, O'Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005;192:795–806.
 
5. Ellerkmann RM, Cundiff GW, Melick CF, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 2001;185:1332–1338.
 
6. Gutman RE, Ford DE, Quiroz LH, et al. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol 2008;199:683. e1–683.e7.
 
7. Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2003;14:122–127.
 
8. Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 2006; 354:1557–1566.
 
9. Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 2012;366:2358–2367.
 
10. van der Ploeg JM, Oude Rengerink K, van der Steen A, et al. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG 2015;122:1022–1030. .
 
11. Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev 2018;8:CD013108.
 
12. Kociszewski J, Rautenberg O, Perucchini D, et al. Tape functionality: sonographic tape characteristics and outcome after TVT incontinence surgery. Neurourol Urodyn 2008;27:485–490.
 
13. Wen L, Shek KL, Dietz HP. Changes in urethral mobility and configuration after prolapse repair. Ultrasound Obstet Gynecol 2019;53:124–128.
 
14. Wei D, Wang P, Niu X, et al. Comparison between laparoscopic uterus/ sacrocolpopexy and total pelvic floor reconstruction with vaginal mesh for the treatment of pelvic organ prolapse. J Obstet Gynaecol Res 2019;45:915–922.
 
15. Culligan PJ, Lewis C, Priestley J, et al. Long-term outcomes of robotic-assisted laparoscopic sacrocolpopexy using lightweight Y-mesh. Female Pelvic Med Reconstr Surg 2020;26:202–206.
 
16. Coolen AWM, van Oudheusden AMJ, Mol BWJ, et al. Laparoscopic sacrocolpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial. Int Urogynecol J 2017;28: 1469–1479.
 
17. Costantini E, Mearini L, Lazzeri M, et al. Laparoscopic versus abdominal sacrocolpopexy: a randomized, controlled trial. J Urol 2016;196:159–165.
 
18. Geynisman-Tan J, Kenton KS, Brown O, et al. Mind the gap: changes in levator dimensions after sacrocolpopexy. Female Pelvic Med Reconstr Surg 2021;27:e184–e186.
 
19. Santoro GA, Wieczorek AP, Stankiewicz A, et al. High-resolution threedimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study. Int Urogynecol J 2009;20:1213–1222.
 
20. Yang J-M, Yang S-H, Huang W-C, et al. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures. Ultrasound Obstet Gynecol 2012;39:458–465.
 
21. Kociszewski J, Rautenberg O, Kolben S, et al. Tape functionality: position, change in shape, and outcome after TVT procedure—mid-term results. Int Urogynecol J 2010;21:795–800.
 
22. Dietz HP, Mouritsen L, Ellis G, et al. How important is TVT location? Acta Obstet Gynecol Scand 2004;83:904–908.
 
23. Gordon D, Groutz A. Evaluation of female lower urinary tract symptoms: overview and update. Curr Opin Obstet Gynecol 2001;13:521–527.
 
24. Shin YS, You JH, On JW, et al. Clinical significance of anatomical urethral length on stress urinary incontinence women. Int J Womens Health 2018; 10:337–340.
 
25. Athanasiou S, Khullar V, Boos K, et al. Imaging the urethral sphincter with three-dimensional ultrasound. Obstet Gynecol 1999;94:295–301.