Hugo Davila, MD Is Lead Author of Study Evaluating the Pubocervical Fascia in Female Pelvic Organ Prolapse

Fort Myers, Fla., June 25, 2021 – Dr. Hugo Davila, who practices urology and minimally-invasive surgery with Florida Healthcare Specialists (FHS), located in Sebastian and Vero Beach, FL, an affiliate practice of Florida Cancer Specialists & Research Institute(FCS), is the lead author of a new study entitled “Evaluation of the Pubocervical Fascia with 3-Dimensional Endovaginal Ultrasonography (EVUS) and Correlation with Intraoperative Findings during Robotic Sacrocervicopexy.” Published recently in the journal Urology, the study evaluated the pubocervical fascia (PF) in patients with pelvic organ prolapse (POP) using three-dimensional endovaginal ultrasonography (EVUS) and then compared the PF appearance to both pelvic examination and intraoperative findings during ultrasonographic robotic-assisted laparoscopic sacrocervicopexy and PF reconstruction (u-RALS-PFR).

Pelvic organ prolapse (POP) is caused by structural defects in the connective tissue and the muscles that support the pelvic viscera. The pubocervical fascia is a common place of injury during labor and delivery and this affects the apical and anterior support.  The repair of these structures is essential during robotic surgery.

In their study, Davila and his co-authors performed a retrospective analysis of 120 women with symptomatic POP using ultrasonography. In an ultrasound, abnormal tissue looks different from healthy tissue; thus, Davila and his fellow researchers were able to identify areas of PF weakness as hypoechoic (dark gray image) and hyperechoic (light gray image) defects (HHD) between the bladder and vagina. A variety of measurements were taken and correlated with the respective stages from the Pelvic Organ Prolapse Quantification (POP-Q) staging system, as well as the findings from u-RALS-PFR.

Results of the study indicated “… a significant association between mean HHD (2.7 cm) and POP-Q stage 3, and between HHD and number of plications (folds) performed during surgery. The larger the HHD, the more severe the POP-Q stage of the anterior compartment of the vaginal wall; thus, more plications were performed on the PF (7-12 plications) during robotic sacrocervicopexy … “

In conclusion, the study stated, “HHD obtained by EVUS was associated with severe POP-Q stage 3 and seemed to correlate with the number of plications during robotic sacrocervicopexy (a procedure to suspend the cervix to the anterior longitudinal ligament of the sacrum). Performing these plications on the pubocervical fascia significantly decreased the length of the anterior vaginal mesh needed for the procedure. These findings may open new applications for preoperative ultrasonography in evaluation and treatment of patients with apical and anterior POP.”

To access the abstract: https://www.goldjournal.net/article/S0090-4295(21)00451-9/fulltext