2043 RELATIONSHIP BETWEEN PHYSICAL EXAMINATION, DYNAMIC MRI, AND INTRA-OPERATIVE FINDINGS IN THE TREATMENT OF PELVIC ORGAN PROLAPSE

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20122043 RELATIONSHIP BETWEEN PHYSICAL EXAMINATION, DYNAMIC MRI, AND INTRA-OPERATIVE FINDINGS IN THE TREATMENT OF PELVIC ORGAN PROLAPSE Forrest Jellison, Ngoc-Bich Le, A. Lenore Ackerman, Lisa Rogo-Gupta, Denise Chow, Karim Chamie, Steven Raman, Larissa V. Rodriguez, and Shlomo Raz Forrest JellisonForrest Jellison Los Angeles, CA More articles by this author , Ngoc-Bich LeNgoc-Bich Le Los Angeles, CA More articles by this author , A. Lenore AckermanA. Lenore Ackerman Los Angeles, CA More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta Los Angeles, CA More articles by this author , Denise ChowDenise Chow Los Angeles, CA More articles by this author , Karim ChamieKarim Chamie Los Angeles, CA More articles by this author , Steven RamanSteven Raman Los Angeles, CA More articles by this author , Larissa V. RodriguezLarissa V. Rodriguez Los Angeles, CA More articles by this author , and Shlomo RazShlomo Raz Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study is to determine the relationship between physical examination (PE), dynamic MRI, and operative findings in the surgical repair of pelvic organ prolapse (POP). METHODS A cohort of 71 patients who underwent surgical repair for anterior compartment prolapse between 2009 and 2011 were selected for a retrospective analysis. Clinical symptoms were determined by validated questionnaires. Preoperative PE and dynamic MRI findings were compared with the intraoperative findings of the anterior, apical and posterior compartments. Dynamic MRI employed a previously described limited T2 weighted Haste sequence. RESULTS A total of 71 patients with a mean age of 64 (range of 33-99, and median 65) were included. The median parity was 2 (range 0–9). The mean score of the PFDI-20 and PFIQ-8 were 125 and 269, respectively. Anterior compartment repair was performed for the entire cohort with concomitant surgical repairs in 89%—49% had apical compartment repair and 74% had repair of the posterior compartment. When dynamic MRI was compared to intraoperative findings, detection of apical compartment prolapse (uterine or vault) had a sensitivity of (100%, 100%), specificity (70%, 95%), and ROC (0.85, 0.97). In contrast, when PE was compared to intraoperative findings of apical compartment prolapse (uterine or vault), detection rate had a sensitivity of (42%, 33%), specificity (86%, 93%), and ROC (0.64,0.63), respectively. In evaluation of the posterior compartment, dynamic MRI and PE had a sensitivity (76%, 85%), specificity (16%, 63%), and ROC (0.16, 0.74) when compared to intraoperative findings. Anterior compartment prolapse detection rates of (93%, 96%) were similar when dynamic MRI and PE were compared to intraoperative findings. Dynamic MRI had additional anatomical findings in 34% of the patients (simple and complex ovarian cysts, nabothian cyst, uterine fibroids, sacral cysts, umbilical and inguinal hernias, ureteral stone, bladder thickening, and hydronephrosis of the kidney). CONCLUSIONS Dynamic MRI was able to predict prolapse for all compartments, but is moderately less reliable for posterior compartment when compared with intraoperative findings. PE was able to predict anterior compartment prolapse but is less reliable for apical and posterior compartments when compared with intraoperative findings. MRI predicted apical prolapse better than PE. Further investigation in evaluation of posterior compartment is warranted. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e824 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Forrest Jellison Los Angeles, CA More articles by this author Ngoc-Bich Le Los Angeles, CA More articles by this author A. Lenore Ackerman Los Angeles, CA More articles by this author Lisa Rogo-Gupta Los Angeles, CA More articles by this author Denise Chow Los Angeles, CA More articles by this author Karim Chamie Los Angeles, CA More articles by this author Steven Raman Los Angeles, CA More articles by this author Larissa V. Rodriguez Los Angeles, CA More articles by this author Shlomo Raz Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...