Supine magnetic resonance defecography for evaluation of anterior compartment prolapse: Comparison with upright voiding cystourethrogram

Kumar, Neil M.; Khatri, Gaurav; Christie, Alana; Sims, Robert; Pedrosa, Iván

doi:10.1016/j.ejrad.2019.05.018

Cited by 11 publications

(4 citation statements)

References 32 publications

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“…A recent study demonstrated lower prevalence and degree of urethral hypermobility and cystoceles on VCUG compared with supine MR defecography [25]. VCUG may demonstrate opacification of urethral diverticula during the voiding phase, which can be associated with UI.…”

Section: Us Pelvis Transperinealmentioning

confidence: 95%

“…VCUG does not provide information regarding global function of the pelvic floor. Furthermore, a recent study showed a lower prevalence and degree of cystoceles and urethral hypermobility on upright VCUG compared with supine MR defecography [25]. Because of its narrow focus on anterior compartment structures, the utility of VCUG is limited to patients with suspected concomitant urinary dysfunction.…”

Section: Initial Imagingmentioning

confidence: 99%

See 1 more Smart Citation

ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

Khatri¹,

Bhosale²,

Robbins³

et al. 2022

Journal of the American College of Radiology

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Section: Us Pelvis Transperinealmentioning

confidence: 95%

Section: Initial Imagingmentioning

confidence: 99%

ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

Khatri¹,

Bhosale²,

Robbins³

et al. 2022

Journal of the American College of Radiology

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“…More recently, a study assessing anterior compartment prolapse showed more severe anterior prolapse and urethral hypermobility on supine MRD than on upright voiding cystourethrogram. 8 For posterior compartment pathology (perineocele, rectocele, rectal prolapse, and anismus), Poncelet et al 9 retrospectively compared upright fluoroscopic defecography to supine MRD in 50 women and revealed similar diagnostic sensitivities. van Iersel et al 10 demonstrated that supine MRD was less sensitive than fluoroscopic defecography for diagnosing rectocele and enterocele but was superior in detection for intussusception.…”

Section: Recommendationsmentioning

confidence: 99%

Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders

Gurland

Khatri

Ram

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…This is especially true when surgical treatment is planned. Hetzer et al 47 retrospectively reviewed the MR defecographic findings for 50 patients with fecal incontinence who were being evaluated for surgical treatment. These findings led to changes in surgical approach in the care of 22 of 33 patients (67%) who subsequently underwent surgery.…”

mentioning

confidence: 99%

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

Bamboriya

Jaipal

Jakhar

2020

IJMBS

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Objective:-This study aims to ascertain the role of MR Defecography in the evaluation of obstructed defecation syndrome (ODS) with objective to describe spectrum of MR Defecography findings in obstructed defecation syndrome (ODS) and describe a number of reference lines and measurement points used to diagnose and grade pelvic floor disorders and Document the MRI appearance of disorders associated with ano-rectal dysfunction. MR Defecography demonstrated the profile of obstructed defecation syndrome on the basis of MR defecography and demonstrate its utility in simultaneous & objective evaluation of all three pelvic compartments. This diagnostic modalities provide a detailed pelvic floor anatomy and functional evaluation, as well as their respective abnormalities, making a precise diagnosis and provides valuable information on treatment planning & decrease chance of postoperative recurrence. Subjects and Methods: It was Cross-sectional and prospective (quantitative) hospital based descriptive type of observational study carried out at a tertiary hospital SMS hospital, jaipur. Chosen the patients diagnosed with ODS as per Rome criteria (III) whose colonoscopy or rectosigmoidoscopy, had been done to rule out other findings from Feb 2018 to September 2019.MR defecography (static and dynamic) with 3 T (PHILIPS INGENIA) MRI system having tunnel configuration. After written and informed consent, patient was positioned supine in MR machine gantry . Static imaging performed in the axial T1WI high resolution, axial, coronal and sagittal T2WI high resolution images at rest for anatomical evaluation. Following this,after ultrasound gel instilled in the patient’s rectum and intravaginaly ,dynamic imaging were taken in the midsagittal plane through the anal canal using a T2 weighted sequence. This sequence was ran for almost 2 min, while the patient performs various maneuvers (Kegel (squeeze), valsalva menuvere (strain), and defecation). MR defecography structurally and functionally evaluated in all 3 pelvic floor compartments and associated defects noted and grading of specific findings like organ specific prolapse, pelvic floor relaxiation and descent were measured. Results: In our study most common findings were pelvic floor descent and anorectal junction descent in 92.68% cases each followed by rectocele in 82.93% cases. Among the females, vaginal/uterine prolapse were observed in 65.31% cases. Least common findings were paradoxical contraction (8.54%) and sigmoidocele (0%). Significant difference was observed in MRI functional parameters in resting state and during defecation/maximal strain position, utilising HMO system for pelvic floor relaxation and descent, as significant difference (p <0.001S) was observed in all parameters including H line, M line, bladder base descent, cervical/vaginal and anorectal junction descent during resting state and during defecation/maximal strain position. Out of 82 conservative biofeedback therapy was given to 79.27 % patients, surgical management was done in (7.32%) and combination of both therapies was given in 13.41% of cases. Out of 82 patients 68.29% showed benefit from management and showed improvement on follow and 31.71% patients were not improved on follow up. Conclusion: As complete survey of the entire pelvis is necessary before surgical repair Magnetic resonance imaging permits evaluation of all three pelvic compartments and as we demonstrated in our study more than one compartment are frequently affected in obstructed defecation syndrome. Static MR Imaging can be also useful to identify the defects responsible for pelvic organ prolapse and stress urinary incontinence, and so help perform site specific repair in surgery, to avoid the high recurrence rates.Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach as detection rate of pathologies increased during defecation / maximal straning as concluded by our study.

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Supine magnetic resonance defecography for evaluation of anterior compartment prolapse: Comparison with upright voiding cystourethrogram

Cited by 11 publications

References 32 publications

ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

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