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Peer-reviewedCC BY 4.0International Urogynecology Journal

MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure

  • Mark E. Lockhart1
  • Pamela A. Moalli2
  • Holly E. Richter3
  • Isuzu Meyer3
  • Allison C. Weidner4
  • Yuko M. Komesu5
  • Benjamin Carper6
  • Marie G. Gantz6
6 affiliations
  1. 1Department of Radiology, University of Alabama at Birmingham, Birmingham, AL USA
  2. 2Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh, Pittsburgh, PA USA
  3. 3Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35243 USA
  4. 4Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC USA
  5. 5Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM USA
  6. 6Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC USA
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Abstract

Introduction and Hypothesis: Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence.

Methods: This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health & Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30–42 months after surgery or prior to 30 months if undergoing reoperation for recurrence.

Results: Of the 88 participants analyzed (aged 65 ± 7.7 years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, p = 0.14. Larger genital hiatus (H-line, 86.5 mm vs 72.3 mm, p = 0.003), low posterior position during strain (M-line, 55.6 mm vs 40.3 mm, p = 0.005), and apical compartments (vaginal apex position below pubococcygeal line (PCL), 42.1 mm vs 13.1 mm, p < 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3 mm vs 41.3 mm, p = 0.04), vaginal circumference (108.5 mm vs 96.1 mm, p = 0.03), and bladder descent vs successes.

Conclusions: Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.

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Cite

BibTeXRIS
BibTeX
@article{lockhart2026parameters,
  title = {{MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure}},
  author = {Mark E. Lockhart and Pamela A. Moalli and Holly E. Richter and Isuzu Meyer and Allison C. Weidner and Yuko M. Komesu and Benjamin Carper and Marie G. Gantz},
  journal = {International Urogynecology Journal},
  year = {2026},
  month = may,
  doi = {10.1007/s00192-026-06699-0},
  url = {https://doi.org/10.1007/s00192-026-06699-0},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - MRI 2-D Parameters Associated with Native Tissue or Transvaginal Mesh Surgical Apical Prolapse Repair Failure
AU  - Mark E. Lockhart
AU  - Pamela A. Moalli
AU  - Holly E. Richter
AU  - Isuzu Meyer
AU  - Allison C. Weidner
AU  - Yuko M. Komesu
AU  - Benjamin Carper
AU  - Marie G. Gantz
PY  - 2026
DA  - 2026/05/30
JO  - International Urogynecology Journal
DO  - 10.1007/s00192-026-06699-0
UR  - https://doi.org/10.1007/s00192-026-06699-0
AB  - Introduction and Hypothesis: Magnetic resonance imaging (MRI) can evaluate individual components of postsurgical recurrent prolapse that may not be visible on physical examination and provide insights into mechanisms of prolapse recurrence.  Methods: This planned prospective secondary imaging analysis at nine clinical sites performed in the Study of Uterine Prolapse Procedures-Randomized (SUPeR) trial of the National Institute of Child Health & Human Development (NICHD) Pelvic Floor Disorders Network (ClinicalTrials.gov: NCT01802281) randomized 183 women to native tissue repair (NTR-hysterectomy) or vaginal mesh repair (VM-hysteropexy) for uterovaginal prolapse, and assessed for surgical failure. A subset of participants who enrolled in Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) underwent MRI at rest, maximal strain, and post-strain rest (recovery) 30–42 months after surgery or prior to 30 months if undergoing reoperation for recurrence.  Results: Of the 88 participants analyzed (aged 65 ± 7.7 years), 22 (25.0%) had surgical failure by clinical criteria, 8/45 (17.8%) VM-hysteropexy; 14/43 (32.6%) NTR-hysterectomy, p = 0.14. Larger genital hiatus (H-line, 86.5 mm vs 72.3 mm, p = 0.003), low posterior position during strain (M-line, 55.6 mm vs 40.3 mm, p = 0.005), and apical compartments (vaginal apex position below pubococcygeal line (PCL), 42.1 mm vs 13.1 mm, p < 0.001) were associated with failure vs success after VM-hysteropexy. In the NTR-hysterectomy group, failures demonstrated greater vaginal width (46.3 mm vs 41.3 mm, p = 0.04), vaginal circumference (108.5 mm vs 96.1 mm, p = 0.03), and bladder descent vs successes.  Conclusions: Pelvic MRI parameters associated with surgical failure vs success varied between VM-hysteropexy and vaginal hysterectomy.
SN  - 0937-3462
SN  - 1433-3023
ER  -