Role of dynamic pelvic floor magnetic resonance imaging (MRI) in the assessment of patients with idiopathic combined faecal and urinary incontinence

Abstract

The aetiology of combined urinary and faecal incontinence (UFI) are interrelated and remain poorly understood; affecting appropriate patient selection, thus accountmg for sub-optimal surgical outcome. A potential variable in this process is Global pelvic floor dysfunction (GPFD). The aim of this study was to prospectively assess whether use of phased array body coil MRI could identify global pelvic floor dysfunction in these patients with multisystem dysfunctional symptoms. Symptomatic parncipants were selected from patients presenting with complaints of combined urinary and faecal incontinence either in the colorectal or urology outpatient clinics. Patients who have had previous pelvic floor surgery were excluded from this study. All underwent standard urodynamics and anorectal physiology assessment. Voiding cystometry, coIonoscopy and endoanal ultrasound were also performed. A standardised protocol was used for the MRI imaging. Thirty individual parameters were measured using buih-in-sofiware (callipers, compass and densitometer). Statistical analysis was performed using SPSS software Nineteen consecutive patients were assessed. Patiems were age, sex and parity matched with asymptomatic controls (n= 11). The MRI procedure was tolerated well by all the participants. Results are shown in the table. Body coil MRI is a non-invasive, well-tolerated imaging modafity. The novel use of MR1 in these patients has demonstrated for the first time distinct anatomical features evident in the levator plate, Urethrovesical angle and anal sphincter complex in patients with GFPD. Our data suggests that body coil dynamic MR1 may have a potential role in identifying patients with global perineal muscle dysfunction, thus facilitating definitive surgical management.