Comparative Pelvic Floor Imaging in the Bladder-Exstrophy-Epispadias-Complex (BEEC)

Abstract

Purpose The congenital bony pelvis and pelvic floor defect highly predisposes females in the BEEC to uterine prolapse. There is a paucity of knowledge about pelvic floor anatomy after reconstruction of the BEEC in long-term follow-up. Material and Methods 19 female BEEC patients (mean age 27.3 years) and 5 controls were included in a cross-sectional study. The pubovisceral muscle was investigated with perineal three-dimensional (3D) ultrasound and MRI. Results 13 females had initial a functional bladder reconstruction, 6 patients got an urinary diversion. 12 patients had a closure of the pelvis either by traction bandage or osteotomy. In 7 patients symphysis was not approximated. 4 BEEC patients had complete uterine prolapse and one partial vaginal prolapse (26%). Symphyseal diastasis measured mean 5.0 cm after symphyseal approximation, 10.4 cm without symphyseal approximation in BEEC and 0.48 cm in controls. Levator hiatus was mean 4.5 cm in sonography and 4.4 cm in MRI after symphyseal approximation, 7.4 cm/5.9 cm without symphyseal approximation and 2.9 cm/4.2 cm in controls. Levator angle was median 85.7°/82.9° after symphyseal approximation, 108.6°/112.9° without symphyseal approximation and 45.1°/71.3° in controls. Prolapse was significant in symphysis >10 cm and levator hiatus > 6 cm. Conclusions This study shows that perineal 3D ultrasound is a useful diagnostic tool in the assessment of the levator ani muscle in BEEC. Established biometric pelvic floor parameter can predict the risk for uterine prolapse. Anterior symphyseal approximation and functional reconstruction allow deeper relocation of the bladder neck into the pelvis documented in a normal levator hiatus width and this might prevent uterine prolapse.