Featured colpo IRM

Dynamic pelvic floor MRI in the exploration of pelvic floor disorders

With the assistance of Dr. Jonathan Ifergan,  Radiologist.

The genital prolapse in women, is a pelvic floor disorder commonly called “descent of genital organs” (bladder, uterus & later on the rectum). It affects approximately 10-20% of women during their life, impacting 30% of post-menopausal women . The pathology is rapidly expanding, particularly due to growth of life expectancy.

Rarely threatening patients life, genital prolapse is causing a major home discomfort while surgical operation is considered as delicate. An accurate diagnosis is necessary to plan appropriate treatment. Diagnosis is based on clinical examination and require, most often, complementary examinations especially the Dynamic pelvic floor MRI.

Additional tests post-clinical examination

A complete clinical examination aims to assess pelvic floor muscles tonicity as well as identify possible pelvic organs lesions.

Top schema

 

Additional examinations will be usually advised to reveal  dysfunctions or positioning anomalies within the pelvic floor organs: rectum and anal canal, uterus and vagina, bladder, urethra and peritoneum.

 

Rectocele- cystocele

 

Further medical exams will become vital for patient concerned especially:

– If the clinical examination highlights problematical findings on more than one compartment,  or a prolapse of the posterior vaginal going along with an hernia projecting into the vagina through the rectum (posterior colpocele).

– Before an operation to correct prolapse located in the pelvis: uterus, bladder, rectum (genital prolapse cure).

– In case of recurrence of prolapse post-surgery.

All these exams contribute to a better display of the pelvic floor structures, observing them at rest as well as during the defecation efforts, they also help identifying possible physiological causes responsible for local functioning disorders experienced by patients. They also enable the staging of potential prolapse, search for associated diseases or possible organic cause. The last years progresses of imaging techniques helped urologists to gain a comprehensive approach of pelvic compartments.

 

Dynamic pelvic floor MRI and colpocysto-defecography

Radio colpo dynamic MRIThe Dynamic pelvic floor MRI or déféco-MRI  allows to explore prolapse of pelvic organs screening  the three pelvic compartments:

  1. Anterior or urinary compartment (bladder and urethra)
  2. Medium or genital compartment (uterus, vagina and cervix in women or prostate in men)
  3. Posterior or Digestive compartment (peritoneum, small intestine and rectum)

The exploration is conducted at rest, under the effect of abdominal thrust and during the exemption, with excellent temporal and spatial resolution together with excellent contrast.

This imaging exam led by a radiologist complete clinical examination of the urologist to provide him with a synthetic analysis of the situation.

 

Its success much depends on the medical team conducting it, both for the images quality and results interpretation.

Nowadays, the Dynamic pelvic floor MRI tends to replace all former radiological techniques, such as the dynamic colpocysto-defecography (CCD), thanks to its multiple advantages:

  1. It evaluates the pelvic floor muscles and ligaments especially the most important ones: the elevator muscles of the anus, compounds of the pubo-rectal and ilio-coccygeal portions.
  2. It allows a precise quantitative measurement of the prolapse and its staging (stage 1: close to the sub pubo-sacrococcygeal (SPSC ) line,  stage 2: close to the vagina, + 1 cm from the SPSC line and stage 3 : externalized).
  3. It can detect and analyze the content of an enterocele – prolapse developed at Douglas’ cul-de-sac, whose content can be in the omentum (peritoneocele), small bowel (enterocele) or sigmoid (sigmoidocele).
  4. It allows to characterize a rectal prolapse, prolapse localized, the most often, on the mucous anterior to the circumferential rectal intussusception.
  5. It can rule out an organic cause (body) as well as an associated pathology (myoma …)
  6. It is not irradiating and does not involve urinary catheter placement (thus limiting the risks of urinary tract infection) nor intravenous injection of contrast medium.
  7. It is fast, lasting less than 20 minutes, unlike colpocysto-defecography that can sometimes last for more than an hour.

The main limitations are:

  1. The risk of underestimating prolapse that tends to increase while been in standing or sitting positions.
  2. Like any MRI, it is contraindicated for pregnant patients, pacemaker bearers, defibrillator or any other metal implant.
  3. It requires an intra-rectal gel injection and patient cooperation.

Conclusions:

Facing pelvic floor disorders, the Dynamic pelvic floor MRI has turned into the most widespread examination at the expense of the colpocysto-defecography.

Shorter and less invasive, Dynamic pelvic floor MRI assesses with high accuracy anomalies found throughout the different pelvic compartments. It also provides morphologic and dynamic elements across the pelvis especially of pelvic floor muscles.

These two methods complement the indispensable pre and post operative clinical examinations. They’re essential prior to conduct any surgical procedure, to obtain a complete morphological assessment and limit the medical intervention to the minimum necessary.

 

Some bibliographic elements:

Dynamic pelvic floor MRI Video

http://www.dailymotion.com/video/x8530h_colpo-irm_tech

The genital prolapse (French)

http://www.reeducationperineale.net/prolapsus_pelvien.html

Dynamic pelvic floor MRI (French)

http://www.fmcgastro.org/postu-main/archives/postu-2002-nantes/le-viscerogramme-pelvien-aujourdhui-lirm-dynamique-du-pelvis/

Advantages/Disadvantages of dynamic pelvic floor MRI (French)

http://www.sifud-pp.org/rc/com/sifud-pp/htm/Article/2011/20111208-090025-019/src/htm_fullText/fr/M%C3%A9moire%20VEJUX%20Nad%C3%A8ge.pdf

http://pe.sfrnet.org/Data/ModuleConsultationPoster/pdf/2006/1/dcf11440-d199-42df-b0b3-49ca84b918d7.pdf

Comparison of dynamic pelvic floor MRI and colpocysto-defecography  (French)

http://onclepaul.net/wp-content/uploads/2011/07/statique-pelvienne-imagerie-2010.pdf

http://www.lapray-radiologie.fr/Les-Troubles-de-la-Statique-99

http://urofrance.org/science-et-recherche/base-bibliographique/article/html/role-de-limagerie-dans-lexploration-des-troubles-de-la-statique-pelvienne.html