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 Gynecology55

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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.