Floor Van Der Pal MD, PhD, Presenter: Nothing to Disclose

Jurgen J. Futterer MD, Abstract Co-Author: Nothing to Disclose

John P.F.A. Heesakkers MD, PhD, Abstract Co-Author: Nothing to Disclose

Stress urinary incontinence is a common condition which can have a major influence on the quality of life. The hypermobile urethra is one of the causes for stress urinary incontinence and can be treated with a Tension-free Vaginal Tape (TVT). Little research has been performed on the latter in relation with hyper mobile urethra and MRI. Furthermore there is no hyper mobile urethra classification. The purpose of our study was to determine whether the hyper mobile urethra and TVT are visible on dynamic pelvic floor MR imaging. A secondary purpose was to determine if dynamic pelvic floor MR imaging can be used to create a hyper mobile urethra classification.

Retrospectively, patients who met the following inclusion criteria were included: dynamic pelvic floor MR imaging and TVT procedure within the period of 2007-2010. The MRI was re-evaluated by one radiologist. Hyper mobile (Arotation) was defined as rotation of the urethra during strain > 30°. The angle between the mid-urethra and the pubococcygeal line was determined during rest (Arest) and strain (Astrain). Arotation = Astrain - Arest.

Four hundred two patients underwent a dynamic pelvic floor MRI during the period of 2007-2010. Thirty-two out of the 402 (8%) patients met the inclusion criteria, all women. Dynamic pelvic floor MR imaging was obtained In 12 preoperative, in 18 postoperative and in 2 both pre and postoperative patients, respectively. Thirteen out of the 14 preoperative patients had a hyper mobile urethra (Arotation > 30°). Preoperatively Arotation was mean 50,9° ± 9,7 (range 26-121). In 8 out of the 20 postoperative patients Arotation was < 30°. Postoperatively Arotation was mean 56,9° ± 45,7 (range 5-142). The TVT was not visible in all postoperative obtained dynamic pelvic floor MRI examinations.

The hypermobile urethra seems to be visible on dynamic MRI in contrary to the TVT. Therefore the dynamic pelvic floor MRI could be used to create a hyper mobile urethra classification. This classification can be used for patient management and therapy evaluation.

This study was performed to determine if dynamic pelvic floor MR imaging can be used to create a hyper mobile urethra classification which can be used for patient management and therapy evaluation.

Van Der Pal, F, Futterer, J, Heesakkers, J, Can Dynamic Pelvic Floor MR Imaging Be Used to Create a Hyper Mobile Urethra Classification?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009724.html