Enterocele associated with rectocele revealed by dynamic pelvic CT

Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT

PURPOSE

This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes.

MATERIALS AND METHODS

A total of 30 female patients with stress urinary incontinence (SUI), anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively.

RESULTS

In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines.

CONCLUSION

Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.

Correlations of anatomical parameters in dynamic pelvic CT and conventional defecography for patients with rectal prolapse

PURPOSE

To evaluate the correlations of anatomical parameters between dynamic pelvic CT (D-PCT) and conventional defecography (CD) for patients with rectal prolapse.

MATERIAL AND METHODS

Anatomical parameters in multislice CT scanning of the pelvis performed at rest and during simulated defecation (D-PCT) were studied with those of CD to evaluate the correlations in both methods for 10 patients with rectal prolapse.

RESULT

The correlation coefficients of the pubococcygeal line and the pubosacral line were r=0.6 and r=0.8 respectively. The length from anal verge to pubococcygeal line and to the pubosacral line showed a good correlation of r=0.7. The length of puborectal muscle showed a good correlation of r=0.8. Anorectal angle was significantly well correlated between two methods (r=0.9, p<0.05). The lengths of anococcygeal length and anosacral length showed a good correlation.

CONCLUSION

The anatomical parameters measured by D-PCT were well correlated with those by CD. D-PCT might be an alternative tool for anatomical evaluation of the anorectal region in patients with rectal prolapse.

Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse

BACKGROUND

Dynamic three-dimensional computed tomography (D-3DCT: high-speed helical scanning during defecation) was used for morphological evaluation of intrapelvic structures in patients with rectal prolapse and rectocele.

METHODS

Twenty-five patients with rectal prolapse or rectocele diagnosed by conventional defecography (CD) or clinical findings were additionally investigated with D-3DCT. D-3DCT images were acquired using a multislice CT system with a 16-row detector during simulated defecation. Helical scanning was performed with a slice thickness of 1 mm, a helical pitch of 15 s/rotation, and a table movement speed of 35 mm/s. The contrast medium, 100 ml of iopamidol (370 mg/ml), was injected at a rate of 2.5 ml/s to enhance contrast with other structures, and scan start was triggered by using a function for automatically determining the optimal scan timing.

RESULTS

Among the eight patients with rectocele, additional intrapelvic disorders were diagnosed in five (enterocele, 4; cystocele, 1; and uterine prolapse, 1) with D-3DCT. In the 17 patients with rectal prolapse, concomitant intrapelvic disorders were found in six (intussusception, 3; cystocele, 2; uterine prolapse, 2; rectocele, 1; and vaginal prolapse, 1).

CONCLUSIONS

D-3DCT can be a useful diagnostic tool for investigation of pelvic pathology in patients with rectocele and rectal prolapse.