Abstract
Objective: To evaluate the association of pelvic organ prolapse (POP) with urinary incontinence (UI) symptoms detected through dynamic magnetic resonance imaging (dMRI) in women without visible prolapse.
Methods: One hundred fifty-eight women undergoing dMRI for disorders related to uterus, ovaries, cervix and vagina with no prolapse on physical examination were enrolled in the study. Women were surveyed for any complaint of UI and if so were requested to fill out the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). M-line, pubococcygeal line (PCL), and mid-pubic line (MPL) were used to detect and grade POP.
Results: The likelihood of POP was similar in women with UI complaints (11%) and those without (15%). UI complaints showed weak correlation with dMRI detected POP only at PCL-M and MPL-M lines (p=0.04, correlation coefficient 0.146, and p=0.02, correlation coefficient 0.170, respectively).
Conclusions: The likelihood of dMRI detected POP is similar in women with UI complaints than those without UI complaints. Although dMRI shows subtle anatomical abnormalities in the connective tissue with high resolution, those anomalies will not lead to UI unless physically diagnosed POP is present.
References
Lalwani N, Moshiri M, Lee JH, Bhargava P, Dighe MK. Magnetic resonance imaging of pelvic floor dysfunction. Radiol Clin North Am. 2013;51(6):1127-1139.
Peter Petros. The Female Pelvic Floor Function, Dysfunction and Management According to the Integral Theory. Second Edition. ISBN 978-3-540-33663-1 Springer Medizin Verlag, Heidelberg; 2007. pp. 41-43.
von Theobald P, Zimmerman CW, Davila GW. New Techniques in Genital Prolapse Surgery, ISBN 978-1-84882-135-4, Springer-Verlag, London; 2011. pp.9-17.
Haylen BT, de Ridder D, Freeman RM, et al.; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20.
El Sayed RF, Alt CD, Maccioni F, et al.; ESUR and ESGAR Pelvic Floor Working Group. Magnetic resonance imaging of pelvic floor dysfunction – joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. Eur Radiol. 2017;27(5):2067-2085.
Pizzoferrato AC, Nyangoh Timoh K, Fritel X, Zareski E, Bader G, Fauconnier A. Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when? Eur J Obstet Gynecol Reprod Biol. 2014;181:259-266.
Singh K, Reid WM, Berger LA. Assessment and grading of pelvic organ prolapse by use of dynamic magnetic resonance imaging. Am J Obstet Gynecol. 2001;185(1):71-77.
Cimsit C, Yoldemir T, Akpinar IN. Prevalence of dynamic magnetic resonance imaging-identified pelvic organ prolapse in pre- and postmenopausal women without clinically evident pelvic organ descent. Acta Radiol. 2016;57(11):1418-1424.
Goh V, Halligan S, Kaplan G, Healy JC, Bartram CI. Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol. 2000;174(3):661-666.
Hecht EM, Lee VS, Tanpitukpongse TP, et al. MRI of pelvic floor dysfunction: dynamic true fast imaging with steady-state precession versus HASTE. AJR Am J Roentgenol. 2008;191(2):352-358.
Lienemann A, Sprenger D, Janssen U, Grosch E, Pellengahr C, Anthuber C. Assessment of pelvic organ descent by use of functional cine-MRI: which reference line should be used? Neurourol Urodyn. 2004;23(1):33-37.
Rosenkrantz AB, Lewis MT, Yalamanchili S, Lim RP, Wong S, Bennett GL. Prevalence of pelvic organ prolapse detected at dynamic MRI in women without history of pelvic floor dysfunction: comparison of two reference lines. Clin Radiol. 2014;69(2):e71-77.
Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994;3(5):291-306.
Diaz DC, Robinson D, Bosch R, et al. Patient‐reported outcome assessment. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence, vol. 1. 6th Tokyo: ICUD ICS; 2017. pp. 541–670.
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14(2):131-139.
Gafni-Kane A, Zhou Y, Botros SM. Predictive modeling and threshold scores for care seeking among women with urinary incontinence: The short forms of the Pelvic Floor Distress Inventory and Urogenital Distress Inventory. Neurourol Urodyn. 2016;35(8):949-954.
Botros S, Gandhi S, Abramov Y, Sand P, Nickolov A, Goldberg R. Normative values for the short forms of the UDI and IIQ in community dwelling women. ICS, Paris, France; 2004. pp. 23–27.
Skorupska K, Grzybowska ME, Kubik-Komar A, Rechberger T, Miotla P. Identification of the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 cutoff scores in urinary incontinent women. Health Qual Life Outcomes. 2021;19(1):87.
Yoldemir T, Erenus M. Should we consider assessment of bone mineral density earlier in postmenopausal women with pelvic organ prolapse? Climacteric. 2011;14(3):392-397.
Swift S, Morris S, McKinnie V, et al. Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):615-620.
Parekh M, Swift S, Lemos N, et al. Multicenter inter-examiner agreement trial for the validation of simplified POPQ system. Int Urogynecol J. 2011;22(6):645-650.
Abrams P, Cardozo L, Fall M, et al. Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-178.
Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10-17.
Broekhuis SR, Kluivers KB, Hendriks JC, Vierhout ME, Barentsz JO, Fütterer JJ. Dynamic magnetic resonance imaging: reliability of anatomical landmarks and reference lines used to assess pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):141-148.
Pannu HK, Scatarige JC, Eng J. MRI diagnosis of pelvic organ prolapse compared with clinical examination. Acad Radiol. 2011;18(10):1245-1251.
Woodfield CA, Hampton BS, Sung V, Brody JM. Magnetic resonance imaging of pelvic organ prolapse: comparing pubococcygeal and midpubic lines with clinical staging. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(6):695-701.
El Sayed RF, El Mashed S, Farag A, Morsy MM, Abdel Azim MS. Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology. 2008;248(2):518-530.
Broekhuis SR, Fütterer JJ, Hendriks JC, Barentsz JO, Vierhout ME, Kluivers KB. Symptoms of pelvic floor dysfunction are poorly correlated with findings on clinical examination and dynamic MR imaging of the pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1169-1174.
Colaiacomo MC, Masselli G, Polettini E, et al. Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 2009;29(3):e35.
DeLancey JO, Morgan DM, Fenner DE, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2 Pt 1):295-302.
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