Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction.

Area of Science:

• Radiology
• Pelvic Floor Disorders
• Medical Imaging

Background:

• Pelvic floor dysfunction is common, with diverse surgical treatments including synthetic mesh and bulking agents.
• Identifying these implanted materials can be challenging due to varied appearances.

Purpose of the Study:

• To review the utility of various imaging modalities for evaluating synthetic materials used in pelvic floor reconstructive surgery.
• To guide clinicians in selecting appropriate imaging techniques for post-operative assessment.

Main Methods:

• Review of imaging characteristics of common surgical materials (bulking agents, slings, mesh).
• Comparison of ultrasonography (US), magnetic resonance (MR) imaging, voiding cystourethrography, and computed tomography (CT) for material depiction.
• Discussion of imaging findings in the context of post-operative complications.

Main Results:

• US and MR imaging are valuable for visualizing urethral bulking agents and midurethral slings.
• MR imaging excels in depicting mesh in deeper pelvic spaces (sacrospinous ligaments, ischiorectal fossae) and sacrocolpopexy mesh.
• US offers better visualization of slings in the urethrovaginal space.
• Scarring can mimic surgical mesh on imaging.
• Voiding cystourethrography and CT have limited direct depiction of implanted materials.

Conclusions:

• US and MR imaging are crucial for evaluating synthetic materials and complications after pelvic floor reconstructive surgery.
• The choice of imaging modality depends on the specific surgical material and suspected pathology.
• Radiologists must be aware of the imaging appearances of various surgical implants to accurately diagnose complications.