Linda Johnston MRCP, Presenter: Nothing to Disclose

Keith Johnston, Abstract Co-Author: Nothing to Disclose

Greg Cario, Abstract Co-Author: Nothing to Disclose

Danny Chou, Abstract Co-Author: Nothing to Disclose

Lynette Masters MD, Abstract Co-Author: Nothing to Disclose

Daniel Aaron Moses MBBS, Abstract Co-Author: Nothing to Disclose

To quantitate the degree of multicompartmental prolapse before and after laparoscopic pelvic floor reconstruction using MRI.

Twenty women (mean age 53 yrs, range 28-73 yrs) with multicompartmental prolapse were imaged before and after laparoscopic pelvic floor reconstructions. Patient consent and IRB approval was sought prior to imaging. A 1.5 T MRI assessed the pelvic floor using the following sequences: sagittal, axial and coronal high resolution T2 TSE sequences at rest; axial, sagittal and coronal ssFSE sequences at rest and during maximal strain; and sagittal and axial steady state preprecession T2 weighted images dynamically while the patient alternated between rest and maximal strain. Quantitative evaluation included construction of the pubococcygeal line (PCL), measurement of the anterior posterior genital hiatus (“H” line), measurement of the vertical decent of the levator hiatus (“M” line) and calculation of levator plate angulation.

A decrease in the AP dimensions of the genital hiatus (H line) was noted postoperatively in 15 of the 20 patients (75%). The mean improvement was 18 mm (range 2 to 81). Pelvic floor decent (M line), improved post operatively in 12 of the 20 patients (60%). The mean improvement was 19 mm (range 4 to 73). A decrease in the degree of levator plate angulation was noted in 17 of the 20 patients (85%). The mean decrease was 19 degrees (range 3 to 56).

Definitive and statistically significant changes were seen in the quantitative parameters before and after laparoscopic pelvic floor reconstruction.Our surgeons believe that the superb, magnified view of the pelvic floor offered by laparoscopy facilitates the optimal approach to reconstructive surgery. This is supported by the post-operative MRI measurement improvements seen in high percentages of patients.

MRI’S role in pelvic floor prolapse continues to develop as a non invasive technique which provides excellent dynamic and static visualization of the pelvic anatomy. MRI offers an objective modality in assessing the outcome of the various techniques of pelvic floor surgery and in doing so will hopefully help define optimal surgical reconstructions

Johnston, L, Johnston, K, Cario, G, Chou, D, Masters, L, Moses, D, Assessment of Changes in Multicompartmental Prolapse after Laparoscopic Pelvic Reconstruction Using Static and Dynamic Magnetic Resonance Imaging.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013144.html