MRI of pelvic organ prolapse

Pannu, Harpreet K.

doi:10.1007/s00330-004-2292-6

Cited by 20 publications

(11 citation statements)

References 38 publications

(91 reference statements)

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“…L'épaisseur normale de l'élévateur va de 3 mm pour le faisceau ilio-coccygien à 5-6 mm pour le faisceau puborectal [22]. Le côté droit apparaît souvent plus fin, ce qui a été attribué successivement à des causes techniques puis au rôle de l'épisiotomie, sans qu'une explication formelle de cet aspect soit actuellement avancée.…”

Section: Musclesunclassified

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Imagerie des prolapsus périnéaux

Lapray¹

2009

Acta Endosc

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L'apport des données de l'imagerie, toujours apprécié à la lumière de la plainte fonctionnelle et de l'examen clinique, peut modifier la chirurgie initialement planifiée.Mots clés Prolapsus génito-urinaire · Descente périnéale · Colpocystodéfécographie · IRM dynamique · Cystocèle · Hystéroptose · Elytrocèle · Rectocèle Abstract Dynamic imaging of prolapses of the four compartments of the pelvic must comply with two principles if it is to be in line with the modern approach to the pelvic floor, which takes the area as a unit. On the one hand, we must consider the competition between the various prolapses, accomplishing an alternation between filling and emptying the hollow organs and pushing back the solid organs in a specific order. On the other, we must ensure maximum abdominal strain. The two principles are in fact connected and have been implemented regularly for 10 years in the two examinations we carry out routinely in the same manner: radiological colpocystodefecography with voiding and defecation views (CCD) and dynamic MRI with defecography (MRId), in which defecation ensures maximum strain and emptying the hollow organs, while solid organs (namely the uterus) can be pushed back.Rigorous application of the technique guarantees almost equivalent results from the two examinations. The CCD provides voiding views and improved analysis of the anorectal pathology (intussusceptions, anismus) but involves radiation and a more invasive examination. It is the goldstandard method, particularly for ano-rectal disorders. MRId has the advantage of providing continuous visibility of the peritoneal compartment and a multiplanar representation, Résumé Deux principes doivent guider l'imagerie dynamique des prolapsus des quatre étages du pelvi-périnée pour répondre à l'approche moderne d'une conception globale du plancher pelvien. C'est d'une part la prise en considération de la compétition des différents prolapsus qui doit faire alterner la réplétion et la vidange des organes creux et le refoulement éventuel des organes pleins dans un ordre précis. C'est d'autre part, la mise en oeuvre d'une poussée abdominale maximale. Ces deux principes sont d'ailleurs liés. Ceux-ci sont mis en oeuvre dans les deux examens que nous réalisons en routine depuis 10 ans avec le même protocole : la colpocystodéfécographie radiologique avec clichés mictionnels et défécographiques (CCD) et l'IRM dynamique avec défécographie (IRMd), où l'exonération garantit la poussée maximum et la vidange des organes creux, tandis que les organes pleins (utérus) peuvent être refoulés.Le respect d'une technique rigoureuse garantit des résultats presque équivalents des deux examens. Les avantages de la CCD sont l'obtention de clichés mictionnels et une meilleure analyse de la pathologie ano-rectale spéci-fique (intussuception, anisme) au prix d'une irradiation et d'un examen plus invasif. Elle reste l'examen de référence en particulier pour la filière ano-rectale. Les avantages de l'IRMd sont la visibilité permanente du compartiment péri-tonéal, des coupes dans ...

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Section: Musclesunclassified

“…La largeur normale du hiatus uro-génital d'environ 3-4 cm au niveau de la symphyse pubienne augmente [22]. Le plan de l'élévateur, qui est normalement parallèle à la LPC avec un axe traversant la symphyse pubienne [23], est situé plus bas dans les prolapsus [22].…”

Section: Musclesunclassified

Imagerie des prolapsus périnéaux

Lapray¹

2009

Acta Endosc

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“…In the past decade MR defecography has become an attractive alternative for conventional defecography to demonstrate pelvic floor dysfunction, since it has multiplanar imaging capabilities, increased soft tissue contrast, and avoids radiation exposure [30,33]. The reported results of studies comparing MR defecography with conventional defecography in patients with pelvic organ prolapse vary [34][35][36][37].…”

Section: Imaging Techniquesmentioning

confidence: 99%

“…The main drawback of MR defecography in patients with predominantly evacuation disorders is the supine patient position required with closed-configuration MR systems. This hampers the evaluation of defecation and straining with as a possible result inaccurate diagnoses regarding the presence and severity of prolapse and suboptimal assessment of evacuation disorders [33]. A vertical open-magnet configuration enables performing dynamic MR imaging in a more physiological position of patient sitting up [38,39].…”

Section: Imaging Techniquesmentioning

confidence: 99%

The current role of imaging techniques in faecal incontinence

Terra

Stoker

2006

Eur Radiol

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Faecal incontinence is a common multifactorial disorder. Major causes of faecal incontinence are related to vaginal delivery and prior anorectal surgery. In addition to medical history and physical examination, several anorectal functional tests and imaging techniques can be used to assess the underlying pathophysiology and to guide treatment planning in faecal incontinent patients. Anorectal functional tests provide functional information, but the potential strength comes from combining test results. Imaging techniques, including defecography, endoanal sonography, and magnetic resonance (MR) imaging, provide structural information about the anorectal region with a direct clinical impact. The major role of imaging techniques in faecal incontinence is visualising the structural and functional integrity of the anal sphincter complex. Both two-dimensional endoanal sonography and endoanal MR imaging are accurate tools to depict anal sphincter defects. The major advantage of endoanal MR imaging is the accurate demonstration of external anal sphincter atrophy. Recent studies have suggested that external phased array MR imaging and three-dimensional endoanal sonography are also valuable tools in the diagnostic work up of faecal incontinence. Decisions about the preferred technique will mainly be determined by availability and local expertise. This article demonstrates the current role of tests, predominantly imaging tests, in the diagnostic work up of faecal incontinence.

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“…One should never hesitate to perform per rectal or bidigital examination which is not only useful in distinguishing between enteroceles and rectoceles, but also effectively evaluates damage to the perineal body. Investigation modalities like ultrasound, MRI, and defecation proctography are underutilized albeit extremely useful adjuncts in the pre-operative planning, especially for recurrent genital prolapse and often reveal unrecognized defects in anatomy and function [5][6][7][8][9]. It is desirable to employ strategies that reduce chronic pelvic floor stress like insuring weight loss, treating constipation and chronic cough [10,11].…”

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confidence: 99%

Pearls and Pitfalls of Mesh Surgery

Rane

Iyer

2012

J Obstet Gynecol India

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AbstractsObjectives This article attempts to offer balanced insight into the use of transvaginal mesh for pelvic organ prolapse especially in the light of the negative publicity in recent times. The role of transvaginal mesh has been in the limelight for a number of reasons and it is important to address this issue in an objective, fair, and balanced manner. The conventional approach to prolapse surgery has undergone a paradigm shift and the principles of mesh replacement surgery sharply contrast with many traditionally held beliefs. This has created a new set of challenges that has revealed a sharp division of opinion among specialists and sub-specialists alike. Conclusion The article is an attempt to explain how mesh surgery can be safely and efficiently performed in carefully selected cases and is based on the combined wisdom of some of the leading surgeons in the sub-specialty today.Keywords Reconstructive pelvic floor surgery Á Use of mesh Á Pearls and pitfalls Although the problem of urinary incontinence and pelvic organ prolapse has been recognized since antiquity, the first mention in the modern era of medicine was only in the midnineteenth century when Marion Sims first sought to establish the relationship of urology and gynecology. The life expectancy for women has almost doubled through the 20th century. With a significant increase in the post-menopausal female population, there is a growing demand for improved quality of life and management of pelvic floor dysfunction [1]. The surgery for pelvic organ prolapse has evolved over the past 200 years and continues to be influenced by dynamically changing concepts, involving not only newer approaches to the difficult problem of recurrent pelvic organ prolapse, but also a renewed understanding of pelvic floor anatomy.It is important that one's approach toward surgery for pelvic organ prolapse (POP) be dictated by patient symptoms. Indeed, operating on ''asymptomatic'' patients is best avoided because the only thing she will get post-operatively is ''symptoms'' [2,3]. Assessment of prolapse needs to done mindful of the day-to-day situations that aggravate it; for example, examining a woman after a bout of exercise. The dorsal or the lithotomy position may not reveal an enterocele, whereas a squatting or a semi-crouching position might be useful [4]. One should never hesitate to perform per rectal or bidigital examination which is not only useful in distinguishing between enteroceles and rectoceles, but also effectively evaluates damage to the perineal body. Investigation modalities like ultrasound, MRI, and defecation proctography are underutilized albeit extremely useful adjuncts in the pre-operative planning, especially for recurrent genital prolapse and often reveal

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MRI of pelvic organ prolapse

Cited by 20 publications

References 38 publications

Imagerie des prolapsus périnéaux

Imagerie des prolapsus périnéaux

The current role of imaging techniques in faecal incontinence

Pearls and Pitfalls of Mesh Surgery

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