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Updated: Sep 19, 2025
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Pelvic Organ Prolapse Quantification After Pessary Removal: The Use of Upright MRI in POP Research
Annemarie van der Steen1,2, Frank F J Simonis3, Anique T M Grob4,5
1Multi Modality Medical Imaging (M3I), TechMed Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands. a.vandersteen-1@utwente.nl.
Introduction:
When pelvic organ prolapse (POP) patients change from pessary to surgical treatment, new POP quantification is often necessary. However, the time to maximal POP recurrence after pessary removal is unclear. This video-article illustrates the variation over time of POP extent after pessary removal.
Methods:
Upright MRI scans of 12 POP patients were used to measure the distances from the lowest points of bladder and cervix to the Pelvic Inclination Correction System (PICS)) line, with the pessary in situ, immediately, 4 and 8 h after pessary removal. Statistical differences between time points were determined.
Results:
The bladder descended immediately after pessary removal from a median of 0.1 cm above to 1.8 cm below the PICS line. In 58% of patients, the bladder then remained stable; in 33%, the bladder further descended up to 5.4 cm after 4 to 8 h. The cervix descended immediately after pessary removal from a median of 3.1 cm to 1.9 cm above the PICS line. In 17% of patients, a late cervix descent after 4-8 h was seen.
Conclusion:
POP quantification should be delayed at least 8 h after pessary removal to prevent underestimation of POP extent.
