Back to the list
Congress: ECR25
Poster Number: C-12027
Type: Poster: EPOS Radiologist (educational)
Authorblock: N. Venugopal, B. Mansoori, P. Bhargava; Seattle, WA/US
Disclosures:
Nitin Venugopal: Nothing to disclose
Bahar Mansoori: Nothing to disclose
Puneet Bhargava: Nothing to disclose
Keywords: Genital / Reproductive system female, Pelvis, Urinary Tract / Bladder, Fluoroscopy, MR, Defecography, Pelvic floor dysfunction
Learning objectives Learning Objectives Review common pelvic floor pathology & surgical management. Provide standardized reporting algorithm and template with sample images & report. Discuss the role of MR defecography in surgical planning. 
Read more Background Background Pelvic organ prolapse affects 40-60% of parous women and is frequently multicomparmental. Involved compartments dictate surgical management and prognosis.  Rectal prolapse is often concurrent with advanced pelvic organ prolapse and often requires combined management by both urogynecology and colorectal surgery specialists. Concurrent anterior and middle compartment prolpase is seen in up to 21-34% of patients with rectal prolapse. Operative success ranges from 19-97%. Cobined repair of pelvic organ prolapse and rectal prolapse is asssociated with better outcomes.
Read more Findings and procedure details Pelvic Measurements & CompartmentsInterpretation of MR defecography requires knowledge of the relevant anatomic compartments and their contents, as illustrated in Figure 1.  Anterior compartment: Bladder, Urethra Middle compartment: Vagina, Uterus Posterior compartment: Rectum   [fig 1] Anatomic relationships within the compartments can be described further with the pubococcygeal line, H-line and M-line as described in Figure 2 and 3. Pubococcygeal line Inferior pubic symphysis to the most inferior coccygeal joint Plane of levator muscle/pelvic floor H-Line Symphysis to posterior anorectal junction AP Diameter of levator hiatus < 6 cm normal M-Line Perpendicular to PCL & intersects...
Read more Conclusion MR Defecography (MRD) plays an important role in pre-operative evaluation of patients with pelvic floor dysfunction. Key Takeaways for Radiologists Interpreting MRD exams: MRD especially useful for posterior compartment to identify patients who need require multidisciplinary surgical management. Obstructive defecation or defecatory dysfunction not explained by physical exam should always be evaluated with MRD. MRD can identify surgically relevant findings that are not apparent on physical exam. Peritoneocele, enterocele, sigmoidocele Rectal prolapse Defecatory effort should be documented in reports, as evaluation is highly dependent on patient effort...
Read more References Wallace S, Gurland B. Approaching Combined Rectal and Vaginal Prolapse. Clin Colon Rectal Surg. 2022 Jan 17;34(5):302-310.  Shah NM, Berger AA, Zhuang Z, Tan-Kim J, Menefee SA. Long-term reoperation risk after apical prolapse repair in female pelvic reconstructive surgery. Am J Obstet Gynecol. 2022 Aug;227(2):306.e1-306.e16.  Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10-7. Umek WH, Morgan...
Read more
GALLERY