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Does Bilateral Sacrospinous Fixation With Synthetic Mesh Recreate Nulliparous Pelvic Anatomy? An MRI Evaluation

Nicolau-Toulouse, Vanessa MD; Tiwari, Pari MD; Lee, Terry PhD; Cundiff, Geoffrey William MD; Geoffrion, Roxana MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2014 - Volume 20 - Issue 4 - p 222–227
doi: 10.1097/SPV.0000000000000066
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Objectives The aim of this study was to determine whether the bilateral sacrospinous vault fixation (BSSVF) with synthetic, polypropylene mesh arms restores the nulliparous anatomic relationships of the vaginal vault in women with and without uterus using magnetic resonance imaging (MRI).

Methods This was a prospective case series of women with symptomatic pelvic organ prolapse (POP) who, after BSSVF, underwent a pelvic MRI (1–13 months postoperatively). Postsurgical pelvic distances were measured from MRI scans and compared with measurements from a group of 11 nulliparous women with adequate pelvic support who underwent MRI in a previous study. Our primary outcome measure was the difference in average distance from the vault to the ischial spine among women after BSSVF when compared with the average nulliparous distances. The secondary outcome measures were the difference in average distance from the posterior fornix to the sacrum and the change in apical POP quantification parameters 6 weeks after surgery.

Results Ten women underwent MRI post-BSSVF—4 women with and 6 women without uterine preservation. In the BSSVF group, similar to the nulliparous group measurements, the average distance between the vaginal apex and the spine was 5.2 cm (SD, 0.8) (95% confidence interval, −0.6 to 0.5; P = 0.92). There was an anterior-inferior displacement of the line between the vaginal apex and the sacrum in women who underwent BSSVF. The posterior fornix was 7.4 cm (SD, 1.2) from the second sacral vertebra versus 5.6 cm (SD, 1.5) in women without POP (P < 0.01). Adequate clinical resolution of apical prolapse was confirmed in all women 6 weeks post-BSSVF.

Conclusions The BSSVF with synthetic mesh restores the anatomy between the vagina and the ischial spines. Clinical studies are underway to compare BSSVF with standard techniques of vaginal vault prolapse repair.

Bilateral sacrospinous fixation with tailored synthetic mesh arms recreates nulliparous anatomy between vaginal vault and ischial spines as imaged via MRI.

From the University of British Columbia, Vancouver, British Columbia, Canada.

Reprints: Roxana Geoffrion, MDCM, FRCSC, Department of Obstetrics and Gynecology, St Paul’s Hospital, University of British Columbia, 1190, Hornby St, 4th floor, Vancouver, British Columbia, V6Z 2K5, Canada. E-mail: roxygeo@hotmail.com.

Funding was provided through the contribution from the Department of Radiology at St Paul’s Hospital and the unrestricted grant from the Providence Health Research Institute.

The authors have declared they have no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins