Short term post-operative morphing of sacrocolpopexy mesh measured by Magnetic Resonance Imaging

Abstract Background Sacrocolpopexy (SC) involves suspension of the vaginal vaultor cervix to the sacrumusing a mesh. Following insertion, the meshes have been observed to have undergone dimensional changes. Objective To quantify dimensional changes of meshes following implantation and characterize their morphology in-vivo. Design setting and participants 24 patients underwent SC using PolyVinyliDeneFluoride mesh loaded with Fe 3 O 4 particles. Tailored anterior and posterior mesh flaps were sutured to the respective vaginal walls, uniting at the apex. The posterior flap continued to the sacrumand was attached there. Meshes were visualized on magnetic resonance (MR) imaging at 12 [3–12] (median [range]) months postoperatively and 3D models of the mesh were generated. Dynamic MR sequences were acquired during valsalva to record mesh mobility. Outcome measures The area of the vagina effectively supported by the mesh (Effective Support Area (ESA)) was calculated. The 3D models’ wall thickness map was analyzed to identify the locations of mesh folding. Intraclass correlation (ICC) was calculated to test the reliability of the methods. To measure the laxity and flatness of the mesh, the curvature and the ellipticity of the sacral flap were calculated. Results The ESA calculation methodology had ICC = 0.97. A reduction of 75.49 [61.55–78.67] % (median [IQR]) in area, 47.64 [38.07–59.81] % in anterior flap, and of 23.95 [10.96–27.21] % in the posterior flap was measured. The mesh appeared thicker near its attachment at the sacral promontory(n = 19) and near the vaginal apex (n = 22). The laxity of the mesh was 1.13 [1.10–1.16] and 60.55 [49.76–76.25] % of the sacral flap was flat. We could not reliably measure mesh mobility (ICC = 0.16). Conclusion A methodology for complete 3D characterization of SC meshes using MR images was presented. After implantation, the supported area is much lower than what is prepared prior to implantation. We propose this happened during the surgery itself.