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01.09.2020 | Original Article

Methods for the defining mechanisms of anterior vaginal wall descent (DEMAND) study

verfasst von: Pamela A. Moalli, Shaniel T. Bowen, Steven D. Abramowitch, Mark E. Lockhart, Michael Ham, Michael Hahn, Alison C. Weidner, Holly E. Richter, Charles R. Rardin, Yuko M. Komesu, Heidi S. Harvie, Beri M. Ridgeway, Donna Mazloomdoost, Amanda Shaffer, Marie G. Gantz, for the NICHD Pelvic Floor Disorders Network

Erschienen in: International Urogynecology Journal | Ausgabe 4/2021

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Abstract

Introduction and hypothesis

The protocol and analysis methods for the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study are presented. DEMAND was designed to identify mechanisms and contributors of prolapse recurrence after two transvaginal apical suspension procedures for uterovaginal prolapse.

Methods

DEMAND is a supplementary cohort study of a clinical trial in which women with uterovaginal prolapse randomized to (1) vaginal hysterectomy with uterosacral ligament suspension or (2) vaginal mesh hysteropexy underwent pelvic magnetic resonance imaging (MRI) at 30–42 months post-surgery. Standardized protocols have been developed to systematize MRI examinations across multiple sites and to improve reliability of MRI measurements. Anatomical failure, based on MRI, is defined as prolapse beyond the hymen. Anatomic measures from co-registered rest, maximal strain, and post-strain rest (recovery) sequences are obtained from the “true mid-sagittal” plane defined by a 3D pelvic coordinate system. The primary outcome is the mechanism of failure (apical descent versus anterior vaginal wall elongation). Secondary outcomes include displacement of the vaginal apex and perineal body and elongation of the anterior wall, posterior wall, perimeter, and introitus of the vagina between (1) rest and strain and (2) rest and recovery.

Results

Recruitment and MRI trials of 94 participants were completed by May 2018.

Conclusions

Methods papers which detail studies designed to evaluate anatomic outcomes of prolapse surgeries are few. We describe a systematic, standardized approach to define and quantitatively assess mechanisms of anatomic failure following prolapse repair. This study will provide a better understanding of how apical prolapse repairs fail anatomically.

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Titel: Methods for the defining mechanisms of anterior vaginal wall descent (DEMAND) study
verfasst von: Pamela A. Moalli
Shaniel T. Bowen
Steven D. Abramowitch
Mark E. Lockhart
Michael Ham
Michael Hahn
Alison C. Weidner
Holly E. Richter
Charles R. Rardin
Yuko M. Komesu
Heidi S. Harvie
Beri M. Ridgeway
Donna Mazloomdoost
Amanda Shaffer
Marie G. Gantz
for the NICHD Pelvic Floor Disorders Network
Publikationsdatum: 01.09.2020
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 4/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04511-1

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Springer Medizin

Methods for the defining mechanisms of anterior vaginal wall descent (DEMAND) study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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