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Updated: Jun 24, 2026
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Effect of a speculum blade on dynamic MRI evaluation of pelvic organ prolapse
Sarah Delaney1, Pedro Fernandez, Amelie N'Guyen
1Hôpital St Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Service de Gynécologie Obstétrique, 184 rue du Faubourg St Antoine, Paris, France.
Abstract:
We aimed to evaluate whether the use of a speculum blade modifies the evaluation of pelvic organ prolapse (POP) as assessed by dynamic magnetic resonance imaging (MRI). Twenty-seven women with POP Quantification (POPQ) stage II or greater, scheduled for POP surgery, were evaluated using MRI. The procedure was repeated using the posterior blade of a standard plastic Grave's speculum to successively retract the anterior and posterior vaginal walls. Standard POPQ was 15% stage II (n =4), 59% stage III (n =16) and 26% stage IV (n =7). The use of a blade evidenced hidden pelvic prolapsed compartments in 59% (n =16) of cases. For 48% of patients (n =13), the variation of the leading edge of at least one additional prolapsed compartment was diagnosed as more than 20 mm. In this series, the use of a speculum blade during dynamic MRI modified the POP evaluation in a large proportion of patients with POP stage > or =II.
Insights
Using a speculum blade during dynamic MRI significantly alters pelvic organ prolapse (POP) evaluations. This method reveals previously hidden prolapse, impacting surgical planning for women with moderate to severe POP.
Area of Science:
- Pelvic Health
- Medical Imaging
- Gynecological Surgery
Background:
- Pelvic organ prolapse (POP) is a common condition affecting women.
- Accurate assessment of POP is crucial for effective surgical planning.
- Dynamic MRI is a valuable tool for evaluating POP.
Purpose of the Study:
- To determine if a speculum blade affects dynamic MRI assessments of POP.
- To quantify the impact of speculum blade use on POP staging and compartment evaluation.
Main Methods:
- Dynamic MRI was performed on 27 women with POP (POPQ stage II or greater).
- The MRI procedure was repeated with a speculum blade retracting vaginal walls.
- Changes in prolapse compartment identification and descent were analyzed.
Main Results:
- The speculum blade identified previously hidden prolapsed compartments in 59% of patients.
- For 48% of patients, the blade altered the leading edge of a prolapsed compartment by over 20 mm.
- POP evaluation was significantly modified in a large proportion of patients with stage II or greater POP.
Conclusions:
- Speculum blade use during dynamic MRI is essential for comprehensive POP assessment.
- This technique can reveal occult prolapse, leading to more accurate surgical indications.
- Dynamic MRI with speculum assistance improves the diagnostic yield for POP evaluation.
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