Value of MRI in the diagnosis of stress urinary incontinence in the absence of organ descent

Purpose: To detect pathomorphological changes of the pelvic floor, the vagi na, and the urethra by MR imaging in patients with stress urinary incontine nce in the absence of organ descent compared with findings in 10 healthy co ntrols. Materials and Methods: The study included 10 healthy controls and 3 8 patients with stage If urinary incontinence showing no urge symptoms but a pathological stress profile on urodynamic testing. The subjects underwent MR imaging with a phased-array coil at 1.5 T in addition to urodynamic tes ting and gynecological examination. The following sequences were used: axia l and coronal PD-weighted TSE sequences with a FOV of 20 cm and a section t hickness of 4 mm; axial STIR sequence. Sagittal T-2-weighted HASTE sequence s were acquired during pelvic floor contraction, relaxation, and straining maneuvers. Results: In 22/38 cases pathomorphological changes were found by MR imaging. The pathomorphological changes were classified as lateral defe cts (n = 14) if the musculofascial connection between the levator muscle an d the lateral vaginal wall or the butterfly shape of the vagina was absent and as central (n = 16) if changes were detected in the urethral wall. Defe cts of the pelvic floor muscles were detected in 8 cases. No underlying cha nges were identified in 16/38 cases. Conclusion: In cases of female urinary incontinence, MR imaging of the pelvic floor can detect pathomorphological changes, which are difficult to identify by clinical examination. MR imagi ng currently does not allow the detection of morphological changes in all f orms of female urinary stress incontinence.