Dynamic pelvic magnetic resonance imaging and cystocolpoproctography altersurgical management of pelvic floor disorders

PURPOSE: Pelvic organ prolapse results in a spectrum of progressively disab ling disorders. Despite attempts to standardize the clinical examination, a variety of imaging techniques are used. The purpose of this study was to e valuate dynamic pelvic magnetic resonance imaging and dynamic cystocolpopro ctography in the surgical management of females with complex pelvic floor d isorders. METHODS: Twenty-two patients were identified from The Johns Hopki ns Pelvic Floor Disorders Center database who had symptoms of complex pelvi c organ prolapse and underwent dynamic magnetic resonance, dynamic cystocol poproctography, and subsequent multidisciplinary review and operative repai r. RESULTS: The mean age of the study group was 58 +/- 13 years, and all pa tients were Caucasian. Constipation (95.5 percent), urinary incontinence (7 7.3 percent), complaints of incomplete fecal evacuation (59.1 percent), and bulging vaginal tissues (54.4 percent) were the most common complaints on presentation. All patients had multiple complaints with a median number of 4 symptoms (range, 2-8). Physical examination, dynamic magnetic resonance i maging, and dynamic cystocolpoproctography were concordant for rectocele, e nterocele, cystocele, and perineal descent in only 41 percent of patients. Dynamic imaging lead to changes in the initial operative plan in 41 percent of patients. Dynamic magnetic resonance was the only modality that identif ied levator ani hernias. Dynamic cystocolpoproctography identified sigmoido celes and internal rectal prolapse more often than physical examination or dynamic magnetic resonance. CONCLUSIONS: Levator ani hernias are often miss ed by physical examination and traditional fluoroscopic imaging. Dynamic ma gnetic resonance and cystocolpoproctography are complementary studies to th e physical examination that may alter the surgical management of females wi th complex pelvic floor disorders.