Static and dynamic MRI of a urinary control intra-vaginal device

Area of Science:

• Urogynecology
• Medical Imaging
• Biomechanical Engineering

Background:

• Stress urinary incontinence (SUI) significantly impacts women's quality of life.
• Nonsurgical management options for SUI are continuously being explored.
• Intravaginal devices (IVDs) offer a potential conservative treatment for SUI.

Purpose of the Study:

• To evaluate the anatomical effects of a commercially available intravaginal device (IVD) on pelvic floor structures during rest and straining using dynamic MRI.
• To understand the mechanism of action of the IVD in relieving SUI symptoms.

Main Methods:

• Pelvic MRI with static and dynamic sequences was performed on ten female patients with SUI.
• Imaging was conducted both without and with a self-inserted IVD during rest and maximal straining.
• Paired t-tests were used to compare key anatomical parameters, including bladder neck position, urethral angulation, and posterior urethro-vesical angle (PUVA).

Main Results:

• The IVD was consistently positioned cranial to the pubo-rectal muscle.
• During straining with the IVD, significant reductions in bladder neck descent (5.2 mm), pubo-urethral angle opening (22 degrees), and bladder neck to pubis distance (5.7 mm) were observed.
• The posterior urethro-vesical angle (PUVA) showed no significant modification.

Conclusions:

• Dynamic MRI provides a non-invasive method to assess the functional impact of IVDs.
• The IVD effectively supports the bladder base and neck, and elevates the urethra towards the pubis during straining.
• These anatomical modifications induced by the IVD suggest a plausible mechanism for SUI relief.