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Schematic in the midsagittal plane shows the three functional anatomic compartments of the female pelvis and the most important pathologic conditions that may occur in each: the anterior compartment (red), containing the bladder (B) and urethra (U); the middle compartment (blue), containing the uterus (Ut), cervix, and vagina (V); and the posterior compartment (green), containing the anus, anal canal, rectum (R), and sigmoid colon. A fourth "virtual" compartment called the cul-de-sac (violet) is also shown. Note that the puborectalis muscle surrounds the bladder neck, vagina, and rectum. PS = pubic symphysis.
Source publication
The purpose of the study is to review the anatomy and etiology of pelvic floor weakness and to highlight the role of MRI as a non invasive method in the assessment of pelvic floor dysfunction in females.
Citations
... The 2019 recommendations of the European Society for Radiology and ESUR/ESGAR outline the HMO system (H line, M line, organ prolapse), which allows for consistent grading of various pelvic floor disorders. HMO is reported on a mid-sagittal image obtained during maximal strain [19].Three points of reference are defined: A, B, and C. A is the inferior margin of the symphysis, B is the convex posterior margin of the puborectalis, and C is the junction of the first and second segments of the coccyx. The fixed reference landmark used universally in reporting pelvic compartment dynamics is the pubococcygeal line (PCL), defined by a line drawn between points A and C, and point B [19]. ...
... HMO is reported on a mid-sagittal image obtained during maximal strain [19].Three points of reference are defined: A, B, and C. A is the inferior margin of the symphysis, B is the convex posterior margin of the puborectalis, and C is the junction of the first and second segments of the coccyx. The fixed reference landmark used universally in reporting pelvic compartment dynamics is the pubococcygeal line (PCL), defined by a line drawn between points A and C, and point B [19]. The H line, also known as the puborectal hiatus line, is the linear distance between points A and B, and represents the maximal widening of the hiatus. ...
... Contents of the anterior compartment include the bladder and urethra. Urethral diverticulum can also be seen, classically obvious on T2-weighted images [19]. In an assessment of the ability of static MRI images to predict urinary incontinence, a 2019 retrospective study demonstrated that the puborectalis muscle was significantly thinner in patients who had urinary incontinence (demonstrated either on physical exam or on urodynamic studies) as compared to continent women [20]. ...
Purpose of review:
This article provides an overview of MRI as a dynamic imaging modality as well as recent updates on the role of MRI in the evaluation of female pelvic floor disorders, including pelvic organ prolapse (POP), rectal prolapse, and defecatory dysfunction.
Recent findings:
Pelvic floor disorders in women are common, and demand for treatment is high. Recently, multidisciplinary guidelines for dynamic MRI have been published to reflect this need. Despite criticisms that MRI is an expensive modality, cost-analysis studies are demonstrating utility for MRI in surgical decision-making trees for patients at risk for treatment failure after POP repairs. Novel measures such as anterior pelvic area and levator volumes are being used to predict and study patients with and at risk for POP. Recent standardized radiographic guidelines as reviewed in this paper will likely lead to improved reproducibility of dynamic MRI techniques across institutions, making complex pelvic floor assessment increasingly accessible to patients while creating opportunities for novel and collaborative research.
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
Введение. Документирующая диагностика цистоцеле, осложненного расстройствами мочеиспускания (РМ), – актуальная клиническая проблема.Цель. Разработка алгоритма для клинико-лучевого стадирования цистоцеле, осложненного РМ.Материалы и методы. Данные комплексного обследования 73 пациенток с цистоцеле, осложненным РМ в виде стрессового недержания мочи и затрудненного мочеиспускания, с использованием статической и функциональной МРТ.Результаты. Разработан алгоритм клинико-лучевого стадирования цистоцеле, основанный на оценке анатомо-томографического состояния парауретрального связочного аппарата и положения мочевого пузыря на основе измерений угла инклинации уретры.Выводы. Алгоритм клинико-лучевого стадирования цистоцеле позволяет провести объективную диагностику цистоцеле, осложненного РМ, способствует снижению количества необоснованных диагностических процедур, дает возможность обосновать тип оперативного лечения.
Introduction. The documenting diagnosis of cystocele complicated by urination disorders (UD) is an urgent clinical problem.Purpose. Development of an algorithm for clinical beam staging of cystocele complicated by UD. Materials and methods. Data from a comprehensive examination of 73 patients with cystocele complicated by UD in the form of stress urinary incontinence and difficulty urinating using static and functional MRI.Results. An algorithm has been developed for clinical and radiation staging of cystocele, based on the assessment of the anatomical and tomographic state of the paraurethral ligamentous apparatus and the position of the bladder based on measurements of the incidence angle of the urethra.Conclusions. The algorithm of clinical beam staging of cystocele allows an objective diagnosis of cystocele complicated by UD, helps to reduce the number of unjustified diagnostic procedures, makes it possible to justify the type of surgical treatment.
Background. Diagnosis of genital prolapse (GP) and stress urinary incontinence (SUI) in women is a complex clinical problem.
Aim. To improve the efficiency of diagnosis of cystocele and SUI by using methods of diagnostic radiology.
Material and methods. Data of comprehensive examination of 73 female patients suffering from GP and SUI with the help of a modified one-hour pad test and MRI.
Results. A positive modified one-hour pad test is a documentary confirmation of minimum volume SUI and an indication for an MRI investigation. If, according to the results of static MRI, there is a damage of the ligaments of the urethra and/or the value of the urethral inclination angle (UIA) is more than 30º, a dynamic MRI needs to be done. At values of UIA over 35º, as revealed by dynamic MRI, cystocele is diagnosed and classified.
Conclusions. The modified one-hour pad test confirms and documents the minimum volume SUI. MRI of the pelvis detects and documents all cases of SUI in women with GP, and allows for an objective diagnosis of cystocele as well as its stage.
