MRI analysis of the musculo-fascial component of pelvic floor in woman before planned vaginal reconstruction procedur for symptomatic pelvic organ prolapse

Česká verzia

Authors: Martin Němec ¹ ; L. Horčička ²; M. Dibonová ¹; M. Krčmář ^3,4; I. Urbánková ^3,4; L. Krofta ^3,4; J. Feyereisl ^3,4
Authors place of work: Gynekologicko-porodnické oddělení, Nemocnice ve Frýdku-Místku, primář MUDr. M. Němec, MBA ¹; Gona s. r. o., Nestátní gynekologické zařízení, Praha, vedoucí MUDr. L. Horčička ²; Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc. ³; 3. lékařská fakulta Univerzity Karlovy, Praha ⁴
Published in the journal: Ceska Gynekol 2018; 83(2): 84-93

Summary

Objective:
The aim of the study is to analyse the musculo-fascial component of the pelvic floor in symptomatic group of woman with pelvic organ prolapse before planned vaginal reconstruction using synthetic vaginal mesh.

Design:
Observational cohort study.

Setting:
Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek; GONA Ltd, Prague; Institute for Care of Mother and Child, Prague; 3rd Faculty of Medicine CHU Prague.

Methodology:
The study involved 285 female volunteers (6 nulliparous, all other patients gave birth vaginally at least once) that in the period 2008–2015 before the planned reconstructive vaginal operations have undergone a comprehensive urogynaecology examination supplemented by magnetic resonance imaging (MRI) of the pelvic floor. Assessed was musculofascial component of the pelvic floor containing -musculus levator ani (MLA), endopelvic fascia (EF) and sacrouterine ligaments (SUL). MLA and EF were evaluated at two levels. The first level corresponds to the puborectalis muscle (evaluation of MRI trauma stage and avulsion), the second level correspondes to the iliococcygeus muscule (evaluation only avulsion injury to the muscle).

Results:
Normal appereance of musculus puborectalis (level 1) was captured only in 25 (8.8) women. In 117 (41.1%) of women were present MRI minor trauma, 143 (50,2%) women were present with MRI major trauma. Avulsion of the muscle was captured in 85 cases (29.8%) at level 1 and in 165 cases (57.9%) in level 2. Preserved architecture of the EF was caught only 99 (34.7%) of the cases in level 1 and in 47 cases (16.5%) in level 2. Sacrouterine ligaments showed normal morphology in 100 cases (35.1%).

Conslusion:
Defects of musculofascial component of the pelvic floor is found frequently in women with symptomatic pelvic organ prolapse. Often a combination of defects MLA, EF and SUL are found. These comprehensive pelvic floor defects require careful urogynecological examination and planing operating methods with a view to minimizing the likelihood of recurrence of the descent. In indicated cases the use of the synthetic vaginal mesh is as a method of first choice.

Keywords:
pelvic organ prolapse, musculofascial component, mesh, MRI, avulsion

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