Dynamic Magnetic Resonance Imaging For Assessment Of Minimally Invasive Pelvic Floor Reconstruction With Polypropylene Implant

Main Category: Urology / Nephrology
Article Date: 24 Jul 2010 - 16:00 PDT

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UroToday.com - Dynamic MRI is recognized as an important tool in the imaging evaluation of pelvic organ prolapse preoperatively. Postoperative dynamic MRI might be helpful to understand the development of recurrent pelvic organ prolapse. Dynamic MRI means that the vagina and the rectum were filled with ultrasound gel before the patients were asked to evacuate the rectal contents during the dynamic MR examination.

In the published study, MRI could detect clinically occult cases of pelvic organ prolapse after pelvic floor repair. In this manner seven out of nine patients with anterior pelvic floor repair by Prolift® anterior presented with newly developed or progressive enterocele or rectocele or both on MRI. Only one enterocele had been diagnosed by physical examination. Furthermore, MRI showed clinically hidden newly developed or increased cystocele in four patients and enlarged enterocele in one patient after posterior repair with Prolift® posterior. These postoperatively detected pelvic floor dysfunctions are probably caused by preoperatively existing multicompartment defects. Even if patients clinically present with a symptom which is specific to a single pelvic compartment, most patients have coexisting compartment defects. A pelvic organ prolapse due to one compartment defect can thereby inhibit a symptomatic defect of another pelvic floor compartment. Hence pelvic organ prolapse can be detectable only after the leading pelvic floor compartment has been repaired.

However, we found that three months after surgery none of the additional MRI detected pathologic findings was related to clinical symptoms of pelvic organ prolapse. Further investigations with long term follow-up are necessary to evaluate the clinical significance of MRI detected findings of pelvic floor dysfunction after the Prolift® procedure. We suppose MRI diagnosis of pelvic organ prolapse precedes clinical symptoms. In our study, six patients (40%) presented with newly developed prolapse and another six patients (40%) presented with increased pelvic organ prolapse on MRI three months after anterior or posterior Prolift® procedure. Possibly a total pelvic floor repair should be considered even if the patient presents with isolated anterior or posterior pelvic floor dysfunction to prevent subsequent pelvic organ prolapse of the untreated compartment.

The most important limitation of the study is the rather low number of cases. However, these are the first results of dynamic MRI after anterior or posterior pelvic floor reconstruction with polypropylene mesh. Larger studies with long-term follow-up are needed to identify patient groups that will benefit from dynamic MRI after pelvic floor repair with regard to early diagnosis and outcome of pelvic organ prolapse.

Written by Katja C. Siegmann, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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