54: Core privileging: Hospitals’ approach to gynecologic surgery

Abstract

the use of dynamic MRI (dMRI) to assess multi-compartment prolapse has added to the understanding of anatomical defects within the pelvic floor. We sought to determine the prevalence of defecatory dysfunction in women with MRI-identified posterior vaginal wall defects (MRIPD). MATERIALS AND METHODS: We retrospectively reviewed data of women who presented to a tertiary referral center for pelvic medicine and underwent a pelvic dMRI. At the time of dMRI, patients were administered an intra-rectal and intra-vaginal mixed solution containing ultrasound gel, barium, and gadolinium. MRI was performed on 1.5T and 3T scanners: Axial, coronal, and sagittal fast T2 sequences (HASTE, SSFSE). Multiple dynamic mid sagittal slices were acquired at rest and during maximal pelvic floor straining. Prolapse of all vaginal compartments was measured and graded by published guidelines. MRIPD was considered present if grade 1 or higher. Physical exam posterior defect (PEXPD) was considered present if Baden-Walker grade 1 or higher. Defecatory symptoms were obtained from the Pelvic Floor Distress Inventory and patient presenting complaint. Defecatory symptoms, MRIPD, and PEXPD were analyzed using logistic regression to calculate adjusted odds ratios; confidence intervals of 95% and p-values of <0.05 were considered significant. RESULTS: Between 1/1/2013 and 7/1/2014, 116 patients underwent dMRI. Median age was 61 years (range 29-87); mean BMI was 26.5 kg/m 2 (range 19-41); median vaginal deliveries was 2 (range 0-8). The overall prevalence of MRIPD was 75.8% (88 of 116); 83.3% (40 of 48) in symptomatic patients and 70.7% (48 of 68) in asymptomatic patients. Overall prevalence of defecatory symptoms was 41.4% (48 of 116). In MRIPD patients only, the prevalence of defecatory symptoms was 45.4% (40 of 88): 43.6% in grade 1; 45.2% in grade 2; 50% in grade 3. Defecatory symptoms were not strongly associated with either MRIPD (OR 1.86, CI 0.64-5.84, p 0.265) or PEXPD (OR 0.614, CI 0.26-1.40, p 0.248), while MRIPD and PEXPD were significantly associated with one another (OR 3.5, CI 1.25-11, p 0.021). CONCLUSION: In conclusion, the prevalence of defecatory symptoms in MRIPD patients was similar across grades. Symptoms were not predictive of MRIPD or PEXPD, with most patients being low grade (1 or 2). The detection of posterior defects on dMRI is high and is commonly associated with symptoms.