PELVIC ORGAN PROLAPSE
Although the evaluation of pelvic organ prolapse has twomenionally been performed with various fluoroscopic methods such as defecography and cystourethrography, these techniques are invasive and unpleasant for the patient. Now, with the increased temporal resolution provided by fast MR imaging techniques, MRI can be utilized for simultaneous evaluation of all three compartments of the pelvic floor in a dynamic fashion (FIGURE 12). MR not only identifies which compartments are prolapsed and determines the degree of prolapse, but also offers a dynamic assessment of the muscular pelvic floor, providing important information for presurgical planning. To date, over 100 of these studies have been performed at NYU.
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Figure 12. Preoperative MRI Assessment for Pelvic Prolapse. A patient with urinary incontinence and symptoms of pelvic prolapse presents for preoperative MR assessment. (A) Midline sagittal T2W HASTE image at rest demonstrates mild pelvic floor laxity and the normally located urinary bladder (b). (B) Image acquired during Valsalva maneuver demonstrates descent of the urinary bladder (b) below the pubic symphysis (p), consistent with a large cystocele. There is also descent of the urethra (white arrow) and rectum (black arrow), consistent with multicompartmental prolapse.