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Li M, Liu T, Wang B, Qiao P, Wang S. MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse. World J Urol 2024; 42:321. [PMID: 38744781 DOI: 10.1007/s00345-024-05014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE Utilize magnetic resonance defecography (MRD) to analyze the primary pelvic floor dysfunctions in patients with stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP), and in SUI patients with asymptomatic POP. METHOD We performed MRD in both SUI and POP subjects. As a primary analysis, the functional MR parameters were compared between the isolated POP and POP combined SUI groups. As a secondary analysis, the functional MR data were compared between the POP combined SUI and the SUI with asymptomatic POP (isolated SUI) groups. RESULTS MRD noted the main characteristics of SUI combined moderate or severe POP, including the shorter closed urethra length (1.87 cm vs. 2.50 cm, p < 0.001), more prevalent urethral hypermobility (112.31° vs. 85.67°, p = 0.003), bladder neck funneling (48.28% vs. 20.51%, p = 0.020), lower position of vesicourethral junction (2.11 cm vs. 1.67 cm, p = 0.030), and more severe prolapse of the posterior bladder wall (6.26 cm vs. 4.35 cm, p = 0.008). The isolated SUI patients showed the shortest length of the closed urethra (1.56 cm vs. 1.87 cm, p = 0.029), a larger vesicourethral angle (153.80° vs. 107.58°, p < 0.001), the more positive bladder funneling (84.85% vs. 48.28%, p = 0.002) and a special urethral opening sign (45.45% vs. 3.45%, p < 0.001). CONCLUSIONS Patients with SUI accompanying POP primarily exhibit excessive urethral mobility and a shortened urethral closure. SUI patients with asymptomatic POP mainly show dysfunction of the urethra and bladder neck, characterized by the opening of the urethra and bladder neck and a shortened urethral closure.
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Affiliation(s)
- Min Li
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China.
| | - Tongtong Liu
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China
| | - Biao Wang
- Department of Urology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China
| | - Peng Qiao
- Department of Urology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China
| | - Sumei Wang
- Department of Gynecology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China.
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Wadhwani S, Ratnaparkhi C, Dhok A. Comparison of Dynamic Magnetic Resonance Defecography With Clinical Examination in Diagnosing Pelvic Floor Dysfunction: An Observational Study. Cureus 2023; 15:e51378. [PMID: 38292993 PMCID: PMC10825726 DOI: 10.7759/cureus.51378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) is frequently reported in both sexes. Dynamic magnetic resonance defecography (DMRD) is the preferred modality, mainly due to its superiority and complementary role in clinical examination. However, studies from the perspective of Indian patients are scarce and mostly restricted to females. Thus, we assessed the diagnostic performance of DMRD in patients with PFD and correlated the findings with those on clinical examination. MATERIALS AND METHODS This prospective, observational study involved 57 adult patients of either sex, presenting with pelvic floor symptoms (PFS) and diagnosed with PFD. Initially, the patients underwent clinical examination, and diagnosis was recorded. Subsequently, the patients were subjected to DMRD. The findings were correlated with the Pearson "r" correlation coefficient. RESULTS A significantly greater proportion of patients had involvement of multiple compartments (36 vs. 12, p<0.001), cystocele (23 vs. 8, p=0.002), and rectal prolapse (25 vs. 14, p=0.030) on DMRD than clinical examination, while there was no significant difference regarding uterine prolapse (p=0.789). Grading of cystocele and rectal prolapse as well as diagnosis of enterocele/peritoneocele, rectocele, and intussusception could be done only with DMRD. DMRD had a strong and significant correlation with clinical examination regarding cystocele (r=0.943, p=0.003), uterine prolapse (r=0.972, p=0.001), and rectal prolapse (r=0.951, p=0.001). CONCLUSIONS DMRD demonstrated significantly better performance in the diagnosis of multiple compartment involvement, cystocele, and rectal prolapse. DMRD and clinical examination were significantly correlated regarding the diagnosis of cystocele, uterine prolapse, and rectal prolapse. Thus, DMRD provides information, in addition to the clinical examination, and should be used in symptomatic patients.
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Affiliation(s)
- Sanajana Wadhwani
- Department of Radiodiagnosis and Imaging, National Cancer Institute, Nagpur, IND
| | - Chetana Ratnaparkhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, IND
| | - Avinash Dhok
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, IND
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Jha P, Sarawagi R, Malik R, Kumar A, Pushpalatha K. Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification. Cureus 2023; 15:e44915. [PMID: 37814774 PMCID: PMC10560544 DOI: 10.7759/cureus.44915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points. METHODS A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements. RESULTS Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse. CONCLUSION POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.
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Affiliation(s)
- Pallavi Jha
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Radha Sarawagi
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Rajesh Malik
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Aman Kumar
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - K Pushpalatha
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, IND
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Zhao Y, Zhang C, Cui C, Zhang X, Zhao Q, Shen W. Longitudinal changes in pelvic organ support among primiparas with postpartum pelvic organ prolapse: A follow-up magnetic resonance imaging study. Int J Gynaecol Obstet 2023. [PMID: 36811173 DOI: 10.1002/ijgo.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/26/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To quantify morphological changes of pelvic floor in primiparas with postpartum pelvic organ prolapse (POP) during the early postpartum period. METHODS A total of 309 primiparas underwent pelvic floor magnetic resonance imaging (MRI) at 6 weeks postpartum. Those primiparas diagnosed with postpartum POP by MRI criterion were followed up at 3 and 6 months postpartum. Normal primiparas were enrolled in the control group. The puborectal hiatus line, muscular pelvic floor relaxation line, levator hiatus area, iliococcygeus angle, levator plate angle, uterus-pubococcygeal line, and bladder-pubococcygeal line were assessed on MRI. Longitudinal changes in pelvic floor measurements between the two groups were compared by repeated-measures analysis of variance. RESULTS Compared with the control group, enlarged puborectal hiatus line, levator hiatus area, and RICA and decreased uterus-pubococcygeal line were observed at rest in the POP group (all P < 0.05). All of the pelvic floor measurements were significantly different in the POP group compared with the control group at the maximum Valsalva maneuver (all P < 0.05). All of the pelvic floor measurements showed no significant change over time in both the POP and control groups (all P > 0.05). CONCLUSIONS Postpartum POP accompanied by poor pelvic floor support will persist in the early postpartum period.
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Affiliation(s)
- Yujiao Zhao
- Department of Radiology, The First Central Clinical College, Tianjin Medical University, Tianjin, China.,Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Cheng Zhang
- Department of Radiology, The First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Can Cui
- Department of Radiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Xiaodong Zhang
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Qian Zhao
- Department of Obstetrics and Gynaecology, Tianjin First Central Hospital, Tianjin, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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The added value of conventional defecography and MRI defecography in clinical decision making on treatment for posterior compartment prolapse. Int Urogynecol J 2023; 34:507-515. [PMID: 35403883 PMCID: PMC9870817 DOI: 10.1007/s00192-022-05181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/04/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Conventional defecography and MRI defecography can be requested as an additional test for diagnosing and differentiating the type of posterior compartment prolapse and/or obstructive defecation disorders. The objective of this study was to determine the added value of conventional defecography, conventional defecography and MRI defecography for clinical decision-making on treatment for patients with posterior compartment prolapse. METHODS Four gynecologists were asked to fill in their treatment plan per patient for 32 cases for three different steps. Step 1 consisted of information on the anamnesis and physical examination (POP-Q). Step 2 consisted of Step 1, including conventional defecography (group A) or MRI defecography (group B). In Step 3, all gynecologists received the information on Step 1 including both conventional defecography and MRI defecography. Data analysis solely focused on the assessment of changes in the gynecological treatment plan of the posterior compartment. RESULTS After Step 2 a change in treatment plan occurred in 37% and 48% of the women in groups A and B, respectively. Accordingly, after Step 3 (including all imaging data), a change in treatment plan occurred in 19% and 52% of the women in groups A and B, respectively. A change within the surgery group (when a different type of surgery was selected) was seen for a total of 11 cases in group A and 20 in group B in all steps combined. CONCLUSIONS Both conventional defecography and MRI defecography had an large effect on the treatment plan for patients with posterior compartment prolapse. The dedicated added value of the imaging modality individually cannot be concluded yet.
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Egorov V, van Raalte H, Takacs P, Shobeiri SA, Lucente V, Hoyte L. Biomechanical integrity score of the female pelvic floor. Int Urogynecol J 2022; 33:1617-1631. [PMID: 35230483 PMCID: PMC9206610 DOI: 10.1007/s00192-022-05120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to develop and validate a new integral parameter, the Biomechanical Integrity score (BI-score), for the characterization of the female pelvic floor. METHODS A total of 253 subjects with normal and pelvic organ prolapse (POP) conditions were included in the multi-site observational, case-control study; 125 subjects had normal pelvic floor conditions, and 128 subjects had POP stage II or higher. A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t-test, correlation) to identify the VTI parameters sensitive to the pelvic conditions. RESULTS Twenty-six parameters were identified as statistically sensitive to POP development. They were subdivided into five groups to characterize (1) tissue elasticity, (2) pelvic support, (3) pelvic muscle contraction, (4) involuntary muscle relaxation, and (5) pelvic muscle mobility. Every parameter was transformed to its standard deviation units against the patient age similar to T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups (1)-(5) and the BI-score in standard deviation units. The p-value for the BI-score has p = 4.3 × 10-31 for POP versus normal conditions. A reference BI-score curve against age for normal pelvic floor conditions was defined. CONCLUSIONS Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the BI-score in future research and practical applications.
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Affiliation(s)
- Vladimir Egorov
- Advanced Tactile Imaging, 1457 Lower Ferry Rd, Trenton, NJ, 08618, USA.
| | | | - Peter Takacs
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
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Diagnostik der Beckenbodeninsuffizienz. COLOPROCTOLOGY 2021. [DOI: 10.1007/s00053-021-00551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Response to letter to editor: "Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification by Swamy et al.". Abdom Radiol (NY) 2021; 46:1467. [PMID: 33885934 DOI: 10.1007/s00261-021-03066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guerra J, Rueda MA, Bedoya N, Murad V. Letter to the editor: "Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification by Swamy et al.". Abdom Radiol (NY) 2021; 46:1465-1466. [PMID: 32601728 PMCID: PMC8096737 DOI: 10.1007/s00261-020-02609-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/15/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
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