PD50-02 IMPACT OF MRI DEFECOGRAPHY ON CLINICAL EVALUATION AND SURGICAL MANAGEMENT OF PELVIC ORGAN PROLAPSE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 2015PD50-02 IMPACT OF MRI DEFECOGRAPHY ON CLINICAL EVALUATION AND SURGICAL MANAGEMENT OF PELVIC ORGAN PROLAPSE Maude Carmel, Gaurav Khatri, April Bailey, and Philippe Zimmern Maude CarmelMaude Carmel More articles by this author , Gaurav KhatriGaurav Khatri More articles by this author , April BaileyApril Bailey More articles by this author , and Philippe ZimmernPhilippe Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There has been an increasing use of MRI defecography (MRID) in the past few years for the evaluation of pelvic organ prolapse (POP). This test can improve the accuracy of POP staging compared to physical examination (PE) or traditional MRI by being a dynamic imaging modality with Valsalva maneuver. Its clinical utility in the decision for surgical treatment has yet to be demonstrated. We evaluated the difference in surgical management based on PE or MRID in patients with POP. METHODS We identified all patients who underwent MRID for the evaluation of POP from 2011 to 2014 at our institution. A blinded fellowship trained FPMRS urologist reviewed all charts. Presence of stage I−II or III−IV cystocele, uterine or apical descent, enterocele or rectocele was assessed according to POP−Q staging that was noted on PE. The degree of confidence in the accuracy of staging for each type of POP was graded on a scale from 1 to 5, 5 being extremely confident. The reviewer selected the indicated surgical treatment and their degree of confidence that this was the best treatment. The same process was repeated using the MRID. POP staging and treatment plan chosen upon PE or MRID were compared. Primary outcome was to assess a change in the surgical plan with MRID. Secondary outcome was to assess a difference in POP staging with MRID. RESULTS A total of 52 patients underwent MRID for the evaluation of POP. The surgical plan based on MRID was different in 7 patients (13.5%) compared to PE. In 6 of these patients, the route of surgery was changed from vaginal to robotic surgery after MRID secondary to a more significant vault descent on MRID compared to PE. The degree of confidence that this was the best treatment was statistically higher after MRID (p<0.001). MRID upstaged the stage of cystocele in 17 patients (32.3%), identified vault descent that was missed on PE in 9 patients (17.3%), enterocele in 9 patients (17.3%) and rectocele in 21 patients (40.4%). The degree of confidence in prolapse staging was statistically higher with MRID (p<0.001). CONCLUSIONS In addition to changing the original surgical treatment plan in one of 7 women tested, MRID increased the physician confidence in diagnosis and selection of the best surgical option. Ref: Zimmern P, Liman H, Nager C et al. Neurourol Urodyn 2014; 33(3):302−6. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLavelle R, Christie A, Alhalabi F and Zimmern P (2015) Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term FollowupJournal of Urology, VOL. 195, NO. 4 Part 1, (1014-1020), Online publication date: 1-Apr-2016. Volume 193Issue 4SApril 2015Page: e1046 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maude Carmel More articles by this author Gaurav Khatri More articles by this author April Bailey More articles by this author Philippe Zimmern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...