Dynamic MRI after surgical repair for pelvic organ prolapse

The purpose of this work was to compare dynamic MRI measurement results from patients with pelvic organ prolapse before and after surgical repair and to correlate postoperative MRI findings with the results of physical examination and patients' complaints.

Thirty women were included in this prospective study. Fifteen patients with uterovaginal or vaginal vault descent and 15 asymptomatic female volunteers underwent dynamic MRI using a single-shot, fast spin-echo sequence with half-Fourier data acquisition. Single-slice midsagittal images of pelvic organs were obtained at maximal pelvic strain and at perineal contraction. Dynamic MRI was repeated on all patients 2-4 months after surgical repair. Postoperative and preoperative dynamic MRIs were compared with the normal values of the volunteer group. Postoperative MRIs were correlated with the clinical findings after surgical repair.

Seven patients reported symptoms after surgical repair, although only two had pathologic findings on physical examination (residual urine associated with third-degree stress urinary incontinence, and bladder neck descent). MRI showed pathologic changes in five of these patients. Two patients with persistent first-degree stress incontinence had no pathologic findings on MRI.

Dynamic MRI is helpful in the evaluation of persistent patient complaints after surgery for pelvic organ prolapse and detects more defects than physical examination does.