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Updated: Jan 13, 2026

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
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Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse

Published on: April 17, 2019

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Assessing Pelvic Organ Prolapse Volume in Patients with Rectal Prolapse via MRI

Shayan Khorsandi1,2, Vipul R Sheth3, Audrey Chow4

  • 1Urogynecology, Stanford University Hospital, Stanford, CA, USA. shayan.drk@gmail.com.

International Urogynecology Journal
|October 28, 2025
PubMed
Abstract

Insights

Magnetic resonance imaging (MRI) defecography accurately measures pelvic organ prolapse (POP) volume in rectal prolapse (RP) patients. Straining measurements (eLASV-S) effectively identify severe POP, guiding surgical decisions.

Area of Science:

  • Pelvic floor disorders
  • Medical imaging
  • Gastroenterology

Background:

  • Pelvic organ prolapse (POP) severity assessment is crucial, especially in rectal prolapse (RP) patients.
  • The role of MRI in quantifying POP in RP patients is not well understood.
  • Accurate POP volume measurement may aid in targeted interventions.

Purpose of the Study:

  • To investigate the utility of MRI defecography in assessing POP volume in patients with RP.
  • To determine if MRI-derived volume measurements can improve screening for symptomatic POP.
  • To assess if POP volume measurements can guide clinical interventions in RP patients.

Main Methods:

  • Retrospective cohort study of 77 women with RP undergoing MRI defecography.
  • Calculation of estimated levator ani subtended volume (eLASV) at rest (eLASV-R) and during strain (eLASV-S).
  • Multivariable regression and Youden's index used to identify significant volume cutoffs.

Main Results:

  • eLASV-S measurements were predictive of symptomatic POP.
  • An eLASV-S cutoff of 102.5 cm³ was significantly associated with the need for surgery.
  • eLASV-S demonstrated superior differentiation between symptomatic and asymptomatic POP compared to eLASV-R.

Conclusions:

  • MRI defecography, specifically eLASV-S, is valuable for identifying high-volume POP in RP patients.
  • A significant eLASV-S cutoff aids in clinical decision-making for POP management.
  • Further prospective studies are recommended to validate MRI's diagnostic potential in POP.
Keywords:
MR defecographyPelvic organ prolapse symptom predictabilityPelvic organ prolapse volumeRectal prolapseeLASV

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