Mind the Gap: Changes in Levator Dimensions After Sacrocolpopexy. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Geynisman-Tan, Julia; Kenton, Kimberly S.; Brown, Oluwateniola; Gillingham, Akira; Lewicky-Gaupp, Christina; Mueller, Margaret G.; Collins, Sarah A.
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 27:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: pelvic floor ultrasound -- levator hiatus -- genital hiatus; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000000881
• Languages: English
• ISSNs: 2151-8378

Abstract

Abstract : Objective: The aim of the study was to compare levator hiatus (LH) and levator area (LA) on transvaginal 3-dimensional (3D) ultrasound (US) and genital hiatus (GH) size by Pelvic Organ Prolapse Quantification (POP-Q) examination before and after minimally invasive sacrocolpopexy. Methods: Women with prolapse (POP) beyond the hymen undergoing minimally invasive sacrocolpopexy without concomitant POP repairs completed Pelvic Floor Distress Inventory short form (PFDI), POP-Q, and transvaginal 3D US before and 14 weeks after surgery. Data were analyzed by 2 urogynecologists, blinded to US image sequence and to corresponding POP-Q scores. Results: Forty-three patients were enrolled; 35 with complete data are included. Patients had a mean ± SD age of 55 ± 11 years. Most were white (89%), vaginally parous (94%), postmenopausal (66%), sexually active (63%), and had stage 3 POP (86%). The majority (89%) had concomitant hysterectomy, and 60% had midurethral slings. At baseline, the mean ± SD PFDI and Prolapse subscale of the Pelvic Floor Distress Inventory scores were 98 ± 50 and 42 ± 22. The median (interquartile range) POP-Q stage decreased after surgery from 3 (3) to 0 (0–1, P < 0.001) and the mean ± SD PFDI scores decreased to 55 ± 42 ( P = 0.002). At baseline, the mean ± SD GH and perineal body measurements were 3.5 ± 0.7 and 2.4 ± 0.6 cm. Although the GH size decreased by 0.5 cm after surgery, perineal body was unchanged. Levator hiatus remained unchanged between the baseline and 14-week visits ( P = 0.07), whereas LA increased by 0.8 cm 2 ( P = 0.03). At 14 weeks, the change in LA was not correlated with the change in GH ( ρ = −0.2, P = 0.2) or POP stage ( ρ = −0.2, P = 0.9). Conclusions: Restoring the apex with sacrocolpopexy alone reduces GH size on clinical examination; however, it does not impact the size of the underlying LH on US.