{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:09:54Z","timestamp":1780445394752,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000010","name":"Ford Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000010","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007911","name":"University of California, San Diego","doi-asserted-by":"publisher","award":["U10 HD054214"],"award-info":[{"award-number":["U10 HD054214"]}],"id":[{"id":"10.13039\/100007911","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006510","name":"Duke University","doi-asserted-by":"publisher","award":["U10 HD041267"],"award-info":[{"award-number":["U10 HD041267"]}],"id":[{"id":"10.13039\/100006510","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008333","name":"University of Alabama at Birmingham","doi-asserted-by":"publisher","award":["U10 HD041261"],"award-info":[{"award-number":["U10 HD041261"]}],"id":[{"id":"10.13039\/100008333","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007179","name":"University of New Mexico","doi-asserted-by":"publisher","award":["U10 HD069025"],"award-info":[{"award-number":["U10 HD069025"]}],"id":[{"id":"10.13039\/100007179","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006920","name":"University of Pennsylvania","doi-asserted-by":"publisher","award":["U10 HD069010"],"award-info":[{"award-number":["U10 HD069010"]}],"id":[{"id":"10.13039\/100006920","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007921","name":"University of Pittsburgh","doi-asserted-by":"publisher","award":["U10 HD069006"],"award-info":[{"award-number":["U10 HD069006"]}],"id":[{"id":"10.13039\/100007921","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007311","name":"Cleveland Clinic","doi-asserted-by":"publisher","award":["U10 HD054215"],"award-info":[{"award-number":["U10 HD054215"]}],"id":[{"id":"10.13039\/100007311","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008199","name":"RTI International","doi-asserted-by":"publisher","award":["U01 HD069031"],"award-info":[{"award-number":["U01 HD069031"]}],"id":[{"id":"10.13039\/100008199","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Eight clinical sites in the US Pelvic Floor Disorders Network.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or Sample<\/jats:title><jats:p>Women who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The MRI (rest, strain) obtained 30\u201342\u2009months after surgery, or earlier for participants with recurrence who desired reoperation before 30\u2009months, were analysed. MRI\u2010based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three\u2010dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Vaginal angulation (upper, lower and upper\u2013lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume) and position (apex, mid\u2010vagina) at rest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 82 women analysed, 12\/41 (29%) in the hysteropexy group and 22\/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (<jats:italic>p<\/jats:italic>\u2009=\u20090.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (<jats:italic>p<\/jats:italic>\u2009=\u20090.01) and mid\u2010vagina (<jats:italic>p<\/jats:italic>\u2009=\u20090.01) at rest than women with successful surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17620","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T09:20:42Z","timestamp":1690795242000},"page":"267-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the <scp>DEMAND<\/scp> study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-8481","authenticated-orcid":false,"given":"Shaniel T.","family":"Bowen","sequence":"first","affiliation":[{"name":"Department of Bioengineering University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela A.","family":"Moalli","sequence":"additional","affiliation":[{"name":"Department of Bioengineering University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Department of Obstetrics, Gynecology &amp; Reproductive Sciences University of Pittsburgh Medical Center, Magee Women's Research Institute  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Abramowitch","sequence":"additional","affiliation":[{"name":"Department of Bioengineering University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3534-7800","authenticated-orcid":false,"given":"Douglas\u00a0H.","family":"Luchristt","sequence":"additional","affiliation":[{"name":"Division of Urogynecology, Department of Obstetrics and Gynecology Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isuzu","family":"Meyer","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Rardin","sequence":"additional","affiliation":[{"name":"Division of Urogynecology Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi S.","family":"Harvie","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael\u00a0E.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Radiology University of California, San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Mazloomdoost","sequence":"additional","affiliation":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Iyer","sequence":"additional","affiliation":[{"name":"Biostatistics Division PPD Incorporated  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Carper","sequence":"additional","affiliation":[{"name":"Social, Statistical, and Environmental Sciences RTI International  Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u00a0G.","family":"Gantz","sequence":"additional","affiliation":[{"name":"Social, Statistical, and Environmental Sciences RTI International  Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the NICHD Pelvic Floor Disorders Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,31]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000297309.25091.a0"},{"issue":"2","key":"e_1_2_11_3_1","first-page":"251","article-title":"Significance of restoration of normal vaginal depth and axis","volume":"36","author":"Nichols DH","year":"1970","journal-title":"Obstet Gynecol"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.23970"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000557"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010020\u201004278\u20105"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001920170016"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10397\u2010014\u20100864\u20102"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/NAU.24781"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00192\u2010021\u201004925\u20105"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.AJOG.2021.05.041"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.12812"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010020\u201004511\u20101"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000270"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2012.05.001"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.CMPB.2021.106175"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010022\u201005172\u2010y"},{"key":"e_1_2_11_18_1","unstructured":"Inc. WR.Mathematica. Version 12. Wolfram Research Inc.; 2020.https:\/\/www.wolfram.com\/mathematica. Accessed August 15 2020."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.18203\/2320\u20101770.IJRCOG20215099"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001652"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/FSURG.2022.760723"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611\u2010197812000\u201000026"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010016\u20102949\u20100"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.113876"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01907072"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010010\u20101648\u20101"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.572"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/AJO.12171"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00192\u2010021\u201004854\u20103"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17620","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T09:06:50Z","timestamp":1705914410000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,31]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1111\/1471-0528.17620"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17620","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,31]]},"assertion":[{"value":"2023-01-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}