Clinical outcomes and vaginal axis on MRI following laparoscopic lateral suspension with mesh for apical and anterior prolapse: A retrospective single center study

Clinical outcomes and vaginal axis on MRI following laparoscopic lateral suspension with mesh for apical and anterior prolapse: A retrospective single center study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 7 April 2025 V1 Latest version Share on Clinical outcomes and vaginal axis on MRI following laparoscopic lateral suspension with mesh for apical and anterior prolapse: A retrospective single center study Authors : Ya Yu 0000-0001-9940-3480 , Heng Zhang , Yueyue Chen , Ling Mei 0000-0001-7061-6757 , Dongmei Wei , and Xiaoyu Niu [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174402915.52050874/v1 259 views 144 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction: Laparoscopic lateral suspension (LLS) with mesh is indicated for the treatment of apical prolapse. However, clinical data of this technique still remain limited. Objective: To evaluate the clinical outcomes and changes in the vaginal axis of LLS with mesh for apical and anterior prolapse. Design: Retrospective single center clinical study. Setting: Conducted at the department of Obstetrics and Gynecology, West China Second University Hospital, China. Sample: Ninety-seven patients underwent LLS between 2020 and 2024. Methods: Retrospective analysis. Main Outcome Measures: Anatomical success rate, subjective cure rate, complications rate and changes in the vaginal axis before and after LLS by magnetic resonance imaging (MRI). Results: The anatomical success rate was 98.97% for apical prolapse and 85.57% for anterior prolapse, with a perioperative complication rate of 3.09% in the two-year follow-up. Mesh exposure at the vaginal cuff was observed in five patients (5.15%), all of whom had a concomitant hysterectomy. The patient satisfactory rate (evaluated by PGI-I score ≤3) was 96.67% at 24 months postoperatively. On MRI, no significant differences were observed between the Post-LLS and nulliparous women regarding the angle between the lower and upper vagina or the Cx/Apical line at rest (p> 0.05). Conclusion: LLS is an effective and safe surgical technique for treatment of apical prolapse with or without anterior prolapse, demonstrating low complication rates and high anatomic curative rates in short-term follow-up. MRI examination showed that a level-Ⅰ defect can be effectively addressed well through LLS, highlighting its capability to restore apical support. Introduction Pelvic organ prolapse (POP) is increasingly recognized as a prevalent condition among older women . While it is not life-threatening, POP can significantly impair a woman’s quality of life, particularly in advanced cases, where it may hinder routine activities and disrupt social interactions . Various surgical techniques are employed in the management of advanced POP. The primary objective of surgical intervention in POP is to alleviate symptoms and restore the pelvic support anatomy. These approaches include both native tissue repair and mesh repair. Although sacrocolpopexy (SCP) is widely regarded as the gold standard for the treatment of apical prolapse, it can be challenging to perform in obese patients due to the difficulty in dissection of the sacral promontory and the associated risk of life-threatening vascular injury in the sacral region. Laparoscopic lateral suspension (LLS) with mesh was first described by Dubuisson et al in 1998 [1]. As an alternative, LLS with mesh has been proposed for the treatment of apical prolapse. A clinical randomized controlled clinical trial by Isenlik et al. demonstrated that the short-term objective and subjective outcomes of LLS were comparable to those of laparoscopic sacrocolpopexy (LSC) with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse [2]. The goal of POP surgery is to enhance functional outcomes through the anatomical correction. It has been hypothesized that the axis, position, and shape of the vagina are crucial factors in maintaining the function of the pelvic floor organs. Sacrocolpopexy and sacrohysteropexy have been shown to change the vaginal axis assessed using magnetic resonance imaging (MRI), as demonstrated in the literature [3-5]. Pulatoğlu et al. conducted a controlled study that reported the near-normal vaginal axis after laparoscopic lateral mesh suspension [6]. However, clinical data regarding changes in the vaginal axis following POP surgery still remain limited. The aim of this retrospective clinical study is to evaluate the clinical outcomes and changes in the vaginal axis, as assessed through MRI, following LLS with mesh for the treatment of apical and anterior prolapse. Specifically, the study examined both objective and subjective outcomes, complications, and the changes in vaginal axis to gain a deeper understanding of the procedure’s long-term effectiveness. Methods This retrospective study was conducted in West China Second University Hospital between 2019 and 2023 and received approval from the Medical Ethics Committee (registration number, 2022-207, approval date, 07.03.2023). All procedures performed in this study adhered to the ethical standards set forth by the institutional research committee. Patients primarily diagnosed with stage II or higher stage apical prolapse with or without anterior prolapse, as determined by the Pelvic Organ Prolapse Quantification (POP-Q) system, who opted for LLS and consented to participate, were enrolled in this study. Demographic and clinical data, including age, body mass index (BMI), obstetric history, menstrual status, comorbidities, urinary incontinence, complications, intraoperative blood loss, pre- and postoperative POP-Q scores, pre- and postoperative pelvic floor questionnaire scores (Pelvic Floor Distress Inventory questionnaire, PFDI-20; Pelvic Floor Impact Questionnaire, PFIQ-7), and other relevant clinical parameters, were collected for analysis. The evaluation of patient satisfaction was assessed using the Patient Global Impression of Improvement (PGI-I) questionnaire. PGI-I scores were classified as follows: scores of 1 (”very much better”), 2 (”better”), and 3 (”a little better”) were categorized as indicative of improvement, whereas scores of 4 (”no change”), 5 (”a little worse”), 6 (”much worse”), and 7 (”very much worse”) were considered indicative of no improvement or worsening of the condition. De-novo anterior, apical and posterior compartment defects were considered as point Ba≥-1, C≥-1, or Bp≥-1 according to the POP-Q. The outcome was considered positive for new-onset UI if the patient had no evidence of UI preoperatively but reported new-onset complaints of UI during the follow-up. All procedures were performed under general anesthesia with the patients in the lithotomy position and steep Trendelenburg. As per standard clinical protocol, the surgical area was prepared with disinfection, and a urinary catheter was inserted. If indicated, hysterectomy, salpingo-oophorectomy or salpingectomy was performed first. LLS was then carried out according to the procedure described by Dubuisson [7], with the exception of Douglas pouch obliteration (McCall’s culdoplasty). In contrast to the routine obliteration as proposed in the original method, this step was performed selectively, only in patients presenting with hernia of the posterior fornix. All surgical procedures were conducted by four senior urogynecologists. A titanised macroporous polypropylene mesh (TiLOOP®, Germany) was used for all patients. Absorbable material was employed for the fixation of the mesh. Postoperative evaluations were scheduled at one month, three months, six months, twelve months, with subsequent annual follow-up visits, to assess patient progress and outcomes over time. MRI for preoperative and postoperative POP patients in our hospital was performed using a 1.5 T scanner (Achieva, Philips Medical Systems) with a phased-array body coil, following the standardized defecatory MRI protocol [8]. The MRI was conducted with the patient in the supine position. Resting images were obtained using T2-weighted fast spin-echo sequences in the axial, coronal, and sagittal planes without fat saturation during active defecation. MRI was conducted at a postoperative follow-up of more than 6 months. Changes in the vaginal axis following LLS with mesh were assessed on MRI by a radiologist (Heng Zhang) with over 10 years of experience in female pelvic imaging. This assessment included the angles between the lower vagina and pubococcygeal line (PCL), the lower and upper vagina, as well as between the levator plate and PCL. In accordance with Figure 4 in the study by Pulatoglu et al. [9], the reverse angle is defined as a negative value, referring to the angles between the lower vagina and PCL, the lower and upper vagina, the levator plate and PCL, as well as posterior urethrovesical angle. In the context of the bladder neck line (BN line), a negative value indicates that the most inferior border of the bladder is located above the PCL, whereas a positive value signifies that the most inferior border of the bladder is positioned blow the PCL. Regarding the Cx line in patients with uterus or uterine cervix, a negative value indicates that the most inferior border of uterine cervix is situated above the PCL, whereas a positive value signifies that the most inferior border of uterine cervix lies below the PCL. In patients without a uterus or uterine cervix, the Apical line is defined as the perpendicular line between the most inferior border of apical vagina to the PCL, with negative and positive values defined in the same manner as for the Cx line. Statistical analysis was performed using SPSS software (version 27.0, IBM Corp, USA). To assess the statistical significance of differences between the two groups, we employed appropriate tests including the t-test, Mann-Whitney U test, as well as Wilcoxon signed-rank test, depending on the data distribution. Results A total of 97 patients were enrolled in the study, with a mean follow-up duration of 25 months. The median age was 60 years. Ten patients (10.31%) had a BMI greater than 28kg/m 2 . Seventy-two patients (74.32%) were postmenopausal. Five patients (5.15%) had a history of total or subtotal hysterectomy , three (3.09%) had undergone previous POP surgery, and one (1.03%) had a history of urinary incontinence (UI) surgery. The median preoperative measurements for Ba, C, Bp were 1, 2.5, -1, respectively. The demographic data and baseline characteristics are presented in Table 1. LLS was performed in all patients, with perioperative complications observed in three cases (3.09%). One patient (1.03%) sustained a bladder injury during the procedure (Clavien-Dindo grade Ⅰ), necessitating urinary catheterization for seven days without further complications. The other two complications occurred postoperatively, one patient (1.03%) developed cerebral infarction (Clavien-Dindo grade Ⅱ) on the first postoperative day, while another (1.03%) experienced pulmonary embolism (Clavien-Dindo grade Ⅱ) on the third postoperative day. The median operative time was 225 minutes, including concomitant procedures. A total of eighty-five patients (87.63%) underwent concomitant procedures. Among the patients, sixty (61.86%) underwent concomitant hysterectomy, eighty-four (86.60%) had concomitant posterior colporrhaphy, two (2.06%) underwent concomitant McCall’s culdoplasty, and one (1.03%) had a concomitant stress urinary incontinence procedure. The median estimated blood loss was 30 ml and the median hospital stay was seven days. The incidence of new-onset posterior POP was 1.03%. The objective cure rates for apical (C＜-1) and anterior (Ba＜-1) prolapse were 98.97% and 85.57%, respectively. Vaginal cuff mesh exposure was observed in five patients (5.15%). Of these, one patient underwent mesh excision in the outpatient department, while the remaining patients were managed conservatively with localized estriol application. Notably, none of the patients reported symptoms related with mesh exposure at their latest follow-up. Perioperative characteristics and postoperative outcomes are presented in Table 2. Preoperative and postoperative symptoms related to POP are summarized in Table 3. The incidence of postoperative new-onset SUI was 8.25%, with no cases of new-onset fecal in continence observed. No patients reported postoperative new-onset constipation. The subjective outcomes, as measured by the PFDI-20, PFIQ-7 questionnaire scores, improved significantly at 3, 6, 12 and 24 months of the follow-up (Table 5). Patient satisfaction, as assessed by PGI-I scores, was notably high. The subjective cure rate (defined as PGI-I ≤3 ) of postoperative 3, 6, 12, 24 months was 93.90%, 97.14%, 98.25% and 96.67%, respectively. The assessment of the vaginal axis in the LLS group was performed at a mean postoperative follow-up of 18 months. MRI was conducted preoperatively in 41 patients and postoperatively in 12 patients. A control group consisting of 28 nulliparous women was also included for comparison. The mean ages of the LLS and control groups were 63.41±10.40 and 27.79±3.58 years, respectively. The control group underwent only resting pelvic MRI for anatomical reference. Compared to the Pre-LLS group, the control group demonstrated significantly lower values in several parameters, including the angled between levator plate and PCL, lower and upper vagina, H-line and PCL, posterior urethrovesical angle, as well as H-line, M-line, BN line, and Cx/Apical line at rest (p＜0.001). No significant difference was noted between the preoperative LLS group (Pre-LLS group) and the control group in the angle between lower vagina and the PCL (p＝0.22). (Table 7) Preoperative and postoperative angle measurements of the included patients were analyzed (Table 8), revealing significant differences between the two groups in the angle between lower and upper vagina and in the Cx/Apical line at both rest and strain (p＜0.05). In the comparison between the postoperative LLS group (Post-LLS group) (Fig.2) and the control group (Table 9, Fig.1), no significant differences were observed in the angles between lower vagina and the PCL (p=0.91), nor between lower and upper vagina (p=0.22). Additionally, no differences were found in the Cx/Apical line at rest between the two groups (p=0.58). Discussion Laparoscopic lateral suspension (LLS), initially introduced by Dubiusson et al., represents a contemporary surgical intervention for the management of apical prolapse. This technique provides a viable alternative to laparoscopic sacrocolpopexy (LSC). Recent studies has demonstrated that LLS w ith hysterectomy yields comparable short-term objective and subjective outcomes to LSC [2, 10]. Notably, in a randomized prospective controlled study by Doğan et al., uterine-preserving LLS was found to be superior in mitigating bladder descent when compared to laparoscopic sacrohysteropexy [11], while providing the a dvantage of improved preservation of the vaginal axis [6]. In our study, we observed a high anatomic success rate for LLS procedure, accompanied by a low incidence of complications, with a perioperative complication rate of 3.09%. The objective cure rates, as measured by POP-Q score, were 98.97% for apical (C＜-1) and 85.57% for anterior (Ba＜-1) prolapse at a mean follow-up duration of 25 months. Mereu et al. evaluated the subjective outcomes of LLS in 125 patients with apical and anterior prolapse, reporting an anatomic success rate of 94.9% for apical POP and 94.2% for anterior POP at two years of follow-up [12] . Yassa et al. found that the anatomic cure rate for uterus-preserving LLS was 100% for apical prolapse and 88.2% for anterior prolapse, with a median follow-up of 24 months [13] . Veit-Rubin et al. reported an anatomic success rate of 98.7% for the anterior compartment and 97.3% for the apical compartment in the uterus-preserving LLS group, while in the LLS with hysterectomy group, the corresponding rates were 94.6% for the anterior compartment and 95.7% for the apical compartment [14] . Chatziioannidou et al. reported an objective cure rate of 87.3% (defined as no prolapse beyond the hymen and no reoperation for POP recurrence) at a mean follow-up of 3.4 years [15]. Several recent randomized controlled trials have demonstrated that the LLS procedure yields results comparable to those of the LSC procedure in managing apical prolapse at one year follow-up [2, 10, 11] . The incidence of complications across the studies ranged from 0% to 5.88% [2, 10-16]. These findings highlight the effectiveness of LLS as a viable surgical option for the management of apical and anterior prolapse. Mesh exposure at the vaginal cuff was noted in five patients (5.15%) in our study, which is higher than the rates reported in some previous studies [10, 12, 15, 17, 18]. Conversely, the series by Dubuisson et al. involving LLS reported a mesh exposure rate approaching 6% [7, 19]. We hypothesize that the incidence of mesh exposure in our study may be attributed to the placement of rectovaginal septum mesh. Moreover, subsequent studies have indicated that the posterior transversal prosthesis in the LLS procedure does not provide substantial benefits [10, 12, 15, 17, 18]. There remains a prevailing concern that the lateral suspension of the apex, particularly in patients without significant rectocele, may predispose to the development of an enterocele or lead to descent of the upper rectum[1, 20, 21]. Recent evidence highlights that for posterior compartment defects, simple posterior colporrhaphy remains the most effective intervention [22]. Additionally, a Cochrane review indicated that vaginal approaches, typically devoid of prosthesis, are more effective for managing posterior compartment defects, with simple posterior colporrhaphy being the preferred technique [23]. Our data suggest that the incidence of de-novo posterior POP is low following the LLS with concomitant posterior colporrhaphy in two-year’s follow-up. Therefore, it may be inferred that for cases involving apical prolapse with concomitant posterior defect, the combination of LLS and posterior colporrhaphy could represent the optimal surgical approach. Pulatoglu et al.[9] reported that the vaginal axis remained close to normal in patients undergoing LLS, with the angles between the PCL and the lower vagina, as well as between the levator plate and the PCL, being comparable between the nulliparous women and Post-LLS patients. This finding suggests that LLS has minimal impact on the alignment of the vaginal axis, thereby preserving its anatomical integrity after surgery. In contrast, our study found that the angle between lower and upper vagina, as well as Cx/Apical line at rest, were similar in both the Post-LLS and control groups. This finding supports the notion that LLS is effective in managing apical compartment defects. Although LLS lifts the upper vagina, decreasing the angle between lower and upper vagina (that is, making it closer to the configuration observed in women without prolapse [24] ), it does not modify the angle between levator plate and PCL, the H line (levator hiatus width), nor the angle between H line and PCL. According to DeLancey’s pelvic support principles [25], a level-Ⅰ (uterosacral-cardinal ligament complex, provides vertical suspension of the uterus and upper vagina) defect can be addressed through LLS procedure by suspending the vagina and cervical ring with mesh, reapproximating the uterosacral ligaments to the rectovaginal fascia and posterior isthm us. Cystocele repair is achieved by the anterior mesh, while posterior support is attained by attaching the mesh to the rectovaginal septum during the LLS procedure. Despite the significant improvements observed postoperatively in the anterior and posterior compartments as indicated by the POP-Q score, our MRI data showed that both the BN line and M line at rest remained comparable between the Pre-LLS and Post-LLS groups. In other words, LLS mainly improve level-Ⅰ defect with no significant impact on the underlying pelvic floor defect, thereby posing a potential risk for prolapse recurrence during long-term follow-up. Therefore, in patients with level-Ⅱ or level-Ⅲ defects, the effectiveness of LLS necessitates prolonged monitoring. Levator ani muscle injury is recognized as a risk factor associated with POP [26], and the LLS procedure did not result in significant changes in measurements related to the levator ani muscle, including the H line, as well as the angles between the levator plate and PCL, and between the H line and PCL. These results indicate that LLS did not lead to significant postoperative improvement in the level-Ⅱ (pubocervical or rectovaginal fasciae and levator ani muscles, maintains the middle vagina, bladder and rectum in normal horizontal positions) and level-Ⅲ (perineal body and anal sphincter, supports the lower vagina and urethra, and maintains the integrity of the urogenital hiatus) supports, which are crucial for maintaining the integrity of the anterior and posterior compartment . Consequently, the LLS procedure may primarily address POP in the level-Ⅰ support, as previously described by Dubiusson et al. [7]. This selective correction may potentially lead to uncertain long-term clinical outcome, with the possibility of anterior and posterior compartment relapse over time. However, both studies were limited by small sample sizes, which may restrict the generalizability of the findings. Further investigation with larger cohorts and extended follow-up periods is necessary to better understand the long-term effectiveness of LLS. In the course of utilizing MRI for vaginal axis parameter measurements, we observed considerable inter-individual variability in the data. This raises concerns regarding the methodological robustness of MRI for this application. MRI offers excellent soft tissue contrast, which allows clear visualization of vaginal structures. Additionally, defecography MRI enables dynamic assessment by comparing pelvic anatomy at rest and during straining. However, its reliability in measuring the vaginal angle is affected by factors such as methodological heterogeneity, patient positioning, the degree of bladder and rectal filling, and pathological confounders [27-29]. In our study, all MRI examinations were performed using standardized protocols, which helped minimize the influence of these confounding factors as much as possible. Despite this, inter-individual variability still persisted, which might be attributed to patient-specific factors such as preoperative anatomical conditions and individual healing responses following surgery. This study has several limitations. First, it utilized a retrospective, single-center design with a short-term follow-up period, and clinical data regarding mid-term and long-term outcomes remain limited. Second, the practical utility and scientific validity of MRI for vaginal axis quantification have not yet been sufficiently validated. Standardized protocols for vaginal axis assessment are still under active investigation within the field, necessitating further empirical exploration to establish evidence-based measurement frameworks and enhance diagnostic reproducibility of medical imaging in POP. Additionally, since our subjects were scanned while they were in the supine positions, it is reasonable to assume that scanning in the upright position would better reflect the anatomic effect of gravity on the levators and pelvic organs. Another limitation is our study lacked surgical confirmation of the imaging findings, which would be inappropriate in living subjects. We also did not compare the outcomes between uterus-preserving LLS and LLS with hysterectomy. Finally, the study did not exclude patients who underwent concomitant posterior colporrhaphy, and the potential impact on posterior compartment was not thoroughly evaluated. Therefore, large-scale, multicenter randomized controlled trials are still required to further evaluate the effectiveness of this surgical technique. Conclusion Laparoscopic lateral suspension (LLS) is an effective and safe surgical technique for treatment of apical prolapse with or without anterior prolapse, demonstrating low complication rates and high anatomic curative rates in short-term follow-up. MRI examination showed that a l evel-Ⅰ defect can be effectively addressed well through LLS, highlighting its capability to restore apical support. This suggests that LLS is a promising option for patients with apical prolapse, offering significant anatomical improvements while maintaining a favorable safety profile. In patients with level-Ⅱ or level-Ⅲ defects, the effectiveness of LLS necessitates prolonged monitoring. Statements and Declarations Acknowledgements: None. Disclosure of Interests: The authors have no conflicts of interest to declare. Authors’ Contribution: Ya Yu: Data collection and management, Data analysis, Manuscript writing/editing. Heng Zhang: Data collection and management, Data analysis, Manuscript writing/editing. Yueyue Chen: Study design, Project development, Administrative support, Manuscript writing/editing. Ling Mei: Manuscript writing/editing. Dongmei Wei: Manuscript writing/editing. Xiaoyu Niu: Study design, Project development, Administrative support, Manuscript writing/editing. Ethics approval: Approval was granted by the Medical Ethics Committee of Second West China Hospital of Sichuan University (registration number, 2022-207, date of approval, 07.03.2023). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Reference 1. Dubuisson J-B, C C. Laparoscopic iliac colpo-uterine suspension for the treatment of genital prolapse using two meshes a new operative laparoscopic approach.pdf. J Gynecol Surg. 1998;14(4):153-92. Isenlik BS, Aksoy O, Erol O, Mulayim B. Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial. Int Urogynecol J. 2023;34(1):231-8.doi:10.1007/s00192-022-05267-63. Juliato CRT, Santos‐Junior LC, de Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation—a randomized trial. Neurourology and Urodynamics. 2019;38(4):1142-51.doi:10.1002/nau.239704. Balgobin S, Good MM, Dillon SJ, Corton MM. Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth. American Journal of Obstetrics and Gynecology. 2013;208(6):488.e1-.e6.doi:10.1016/j.ajog.2013.03.0065. Senturk MB, Kilicci C, Aydin S, Polat M, Abide Yayla C, Karateke A. Vaginal axis on MRI after unilateral and bilateral sacral hysteropexy: a controlled study. Journal of Obstetrics and Gynaecology. 2017;38(1):115-20.doi:10.1080/01443615.2017.13367546. Pulatoğlu Ç, Yassa M, Turan G, Türkyılmaz D, Doğan O. Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study. International Urogynecology Journal. 2020;32(4):851-8.doi:10.1007/s00192-020-04596-87. Dubuisson JB, Yaron M, Wenger JM, Jacob S. Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients. J Minim Invasive Gynecol. 2008;15(1):49-55.doi:10.1016/j.jmig.2007.11.0038. Ye P, Ning G, Cui T, et al. Magnetic resonance defecography: Post-defecation straining detects more and maximal prolapse in the anterior and middle compartments. European Journal of Radiology. 2024;181.doi:10.1016/j.ejrad.2024.1117579. Pulatoglu C, Yassa M, Turan G, Turkyilmaz D, Dogan O. Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study. Int Urogynecol J. 2021;32(4):851-8.doi:10.1007/s00192-020-04596-810. Malanowska-Jarema E, Starczewski A, Melnyk M, Oliveira D, Balzarro M, Rubillota E. A Randomized Clinical Trial Comparing Dubuisson Laparoscopic Lateral Suspension with Laparoscopic Sacropexy for Pelvic Organ Prolapse: Short-Term Results. Journal of Clinical Medicine. 2024;13(5).doi:10.3390/jcm1305134811. Doğan O, Yassa M, Eren E, Birol İlter P, Tuğ N. A randomized, prospective, controlled study comparing uterine preserving laparoscopic lateral suspension with mesh versus laparoscopic sacrohysteropexy in the treatment of uterine prolapse. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2024;297:120-5.doi:10.1016/j.ejogrb.2024.03.04212. Mereu L, Tateo S, D’Alterio MN, et al. Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Eur J Obstet Gynecol Reprod Biol. 2020;244:16-20.doi:10.1016/j.ejogrb.2019.10.02613. Yassa M, Tug N. Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up. Geburtshilfe Frauenheilkd. 2019;79(9):983-92.doi:10.1055/a-0941-348514. Veit-Rubin N, Dubuisson J, Constantin F, et al. Uterus preservation is superior to hysterectomy when performing laparoscopic lateral suspension with mesh. Int Urogynecol J. 2019;30(4):557-64.doi:10.1007/s00192-018-3678-315. Chatziioannidou K, Veit-Rubin N, Dallenbach P. Laparoscopic lateral suspension for anterior and apical prolapse: a prospective cohort with standardized technique. Int Urogynecol J. 2022;33(2):319-25.doi:10.1007/s00192-021-04784-016. Campagna G, Vacca L, Panico G, et al. Laparoscopic lateral suspension for pelvic organ prolapse: A systematic literature review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;264:318-29.doi:10.1016/j.ejogrb.2021.07.04417. Russo E, Giannini A, Guevara MM, et al. Medium-term outcomes after robotic-assisted lateral suspension with mesh for advanced multi-compartmental prolapse. International Urogynecology Journal. 2019;31(8):1647-53.doi:10.1007/s00192-019-04069-718. Dallenbach P, Alec M, Boulvain M, Shabanov S. Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse. J Robot Surg. 2022;16(2):287-94.doi:10.1007/s11701-021-01234-319. Dubuisson JB, Eperon I, Jacob S, et al. [Laparoscopic repair of pelvic organ prolapse by lateral suspension with mesh: a continuous series of 218 patients]. Gynecologie, obstetrique & fertilite. 2011;39(3):127-31.doi:10.1016/j.gyobfe.2010.12.00720. Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, Lange S, Eperon I, Dubuisson J. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J. 2017;28(11):1685-93.doi:10.1007/s00192-017-3327-221. Dubuisson J, Eperon I, Dällenbach P, Dubuisson J-B. Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh. Archives of Gynecology and Obstetrics. 2012;287(2):307-12.doi:10.1007/s00404-012-2574-122. Mulayim B, Sendag F. Modified Laparoscopic Lateral Suspension: The Mulayim Technique. J Minim Invasive Gynecol. 2019;26(3):407-8.doi:10.1016/j.jmig.2018.07.01423. Mowat A, Maher D, Baessler K, Christmann-Schmid C, Haya N, Maher C. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev. 2018;3(3):Cd012975.doi:10.1002/14651858.Cd01297524. Ginath S, Garely A, Luchs JS, et al. MRI pelvic landmark angles in the assessment of apical pelvic organ prolapse. Archives of Gynecology and Obstetrics. 2010;284(2):365-70.doi:10.1007/s00404-010-1648-125. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717-24; discussion 24-8.doi:10.1016/0002-9378(92)91562-o26. Horcicka L, Krcmar M, Nemec M, Hympanova L, Feyereisl J, Krofta L. Appearance of levator ani muscle subdivision defects on level III vaginal support structures in women with and without pelvic organ prolapse: an MRI study. International Urogynecology Journal. 2023;34(8):1971-82.doi:10.1007/s00192-023-05533-127. Luo J, Betschart C, Ashton-Miller JA, DeLancey JOL. Quantitative analyses of variability in normal vaginal shape and dimension on MR images. International Urogynecology Journal. 2016;27(7):1087-95.doi:10.1007/s00192-016-2949-028. Sinex DCE, Bowen ST, Kashkoush A, et al. The establishment of a 3D anatomical coordinate system for defining vaginal axis and spatial position. Computer Methods and Programs in Biomedicine. 2021;208.doi:10.1016/j.cmpb.2021.10617529. Broekhuis SR, Fütterer JJ, Barentsz JO, Vierhout ME, Kluivers KB. A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks. International Urogynecology Journal. 2009;20(6):721-9.doi:10.1007/s00192-009-0848-3 Supplementary Material File (figures.docx) Download 184.59 KB File (tables.docx) Download 39.40 KB Information & Authors Information Version history V1 Version 1 07 April 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords gynaecological surgery: laparoscopy gynaecological surgery: prolapse gynaecological surgery: urogynaecological radiological imaging: magnetic resonance scan urogynaecology Authors Affiliations Ya Yu 0000-0001-9940-3480 West China Second University Hospital View all articles by this author Heng Zhang Ministry of Education View all articles by this author Yueyue Chen West China Second University Hospital View all articles by this author Ling Mei 0000-0001-7061-6757 West China Second University Hospital View all articles by this author Dongmei Wei West China Second University Hospital View all articles by this author Xiaoyu Niu [email protected] West China Second University Hospital View all articles by this author Metrics & Citations Metrics Article Usage 259 views 144 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Ya Yu, Heng Zhang, Yueyue Chen, et al. Clinical outcomes and vaginal axis on MRI following laparoscopic lateral suspension with mesh for apical and anterior prolapse: A retrospective single center study. Authorea . 07 April 2025. DOI: https://doi.org/10.22541/au.174402915.52050874/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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