Preoperative level II/III MRI measures predicting long-term prolapse recurrence after native tissue repair.

INTRODUCTION AND HYPOTHESIS: To identify preoperative level II/III MRI measures associated with long-term recurrence after native tissue prolapse repair. METHODS: Women who previously participated in pelvic floor research involving MRI prior to undergoing primary native tissue prolapse repair were recruited to return for repeat examination and MRI. Recurrence was defined by POP-Q (Ba/Bp > 0 or C > -4), repeat surgery, or pessary use. Preoperative MR images were used to perform five level II/III measurements including a new levator plate (LP) shape analysis at rest and maximal Valsalva. Principal component analysis (PCA) was used to evaluate LP shape variations. Principal component scores calculated for two independent shape variations were noted. RESULTS: Thirty-five women were included with a mean follow-up of 13.2 ± 3.3 years. Nineteen (54%) were in the success group. There were no statistical differences between success versus recurrence groups in demographic, clinical, or surgical characteristics. Women with recurrence had a larger preoperative resting levator hiatus [median 6.4 cm (IQR 5.7, 7.1) vs. 5.8 cm (IQR 5.3, 6.3), p = 0.03]. This measure was associated with increased odds of recurrence (OR 8.2, CI 1.4-48.9, p = 0.02). Using PCA, preoperative LP shape PC1 scores were different between success and recurrence groups (p = 0.02), with a more dorsally oriented LP shape associated with recurrence. CONCLUSIONS: Larger preoperative levator hiatus at rest and a more dorsally oriented levator plate shape were associated with prolapse recurrence at long-term follow-up. For every 1 cm increase in preoperative resting levator hiatus, the odds of long-term prolapse recurrence increases 8-fold.