Defining Mechanisms of Anterior Vaginal Wall Descent

Women who are enrolled in the SUPeR study, a study comparing two common vaginal surgeries for uterine prolapse, are also eligible to participate in the DEMAND trial. DEMAND is a sub-study or ancillary study of SUPeR. In this study, we will learn more about how surgery impacts the position of the vagina, bladder and bowel in the years following a SUPeR surgery. We will also learn about the durability of the SUPeR surgeries.

Unfortunately, among women who have surgery to repair pelvic organ prolapse, as many as 30%, will require additional surgery in the future to correct prolapse due to a failure of their initial surgery, or to treat a related problem such as urinary incontinence. Doctors have been very interested in learning which women might be at risk for this recurrent prolapse, and whether women who have some surgical procedures are less likely to require additional surgery. Doctors are also very interested in WHY this prolapse occurs, WHERE it occurs, and HOW it occurs.

The DEMAND study is being done to learn about changes in vaginal shape and position after different surgeries to repair pelvic organ prolapse. The investigators have two main goals in this study:

  1. To identify whether the position of the vagina after surgery for prolapse differs depending upon the type of surgery a woman has undergone.
  2. To identify how factors such as obesity, age, number of vaginal births, longstanding constipation may contribute to these changes.

Women who are enrolled in SUPeR will undergo a Magnetic Resonance Imaging test (MRI) three years after their SUPeR surgery, or at the time of reoperation for recurrent prolapse, whichever comes first. The images of the pelvis obtained during the MRI will help us to identify the differences mentioned above, which may result in both improvements in prolapse repair techniques as well as counseling of women prior to these repairs.