Comparison of dynamic MRI vaginal anatomical changes after vaginal mesh surgery and laparoscopic sacropexy

The aim of this study is to evaluate anatomical differences in vaginal length and axis between transvaginal mesh surgery (TVM) and laparoscopic sacropexy (LSC) by pelvic magnetic resonance imaging (MRI). Twenty-seven women with stage II or more symptomatic pelvic organ prolapse were involved in this study. Thirteen patients had undergone TVM, and fourteen had LSC. Preoperative and at 1 year postoperative clinical examination and dynamic MRI were performed. The angle between the vaginal axis and horizontal line or pubococcygeal line and the position of the Douglas pouch were evaluated on MRI. In clinical examination, all compartments (Aa, Ba, C, Ap, Bp, D) were significantly improved after both surgeries. Point C and D tended to be higher after LSC than TVM. In MRI assessment, the position of the Douglas was positioned significantly higher after LSC than TVM. There was no difference in postoperative vaginal axis at rest between the two surgical techniques, but the vaginal axis with maximal strain after TVM was more horizontal than LSC (LSC 143.7 ± 6.3° vs. TVM 155.1 ± 12.3°, p = 0.003). As a result, the change of vaginal axis from at rest to maximal strain was also apparently greater after TVM. (LSC 10.3 ± 9.1° vs. TVM 20.7 ± 11.3°, p = 0.014). Both TVM and LSC significantly improved pelvic organ descent evaluated by clinical examination and MRI. LSC suspends the uterus, and Douglas pouch was significantly higher than TVM. The vaginal axis at rest leans horizontally after both surgeries, but the change of vaginal axis from at rest to maximal strain was significantly higher after TVM.