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Session: Soft Tissue & Abdominal Organs
Session starts: Thursday 24 January, 13:30
Presentation starts: 14:45
Room: Lecture room 559

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Anique Grob ()
Judith olde Heuvel ()
Jurgen Futterer ()
Diana Massop ()
Angelique Veenstra van Nieuwenhoven ()
Frank Simonis ()
Huub van der Vaart ()

Abstract:
Objective: Pelvic organ prolapse is clinically diagnosed in supine position, even though complaints mostly occur in upright position. In clinical practice the effect of gravity is usually simulated by having the patients put strain on their pelvic floor by performing a Valsalva manoeuvre, while being in supine position. The objective of this study was to evaluate the efficacy of MRI in determining the effect of gravitation and the true extent of prolapse in the standing position. Methods: This prospective study was conducted with symptomatic pelvic organ prolapse grade ≥ 2 patients. Fifteen female patients were examined with a tilting Magnetic Resonance Imaging (MRI) system, to allow supine and upright imaging of the pelvic floor. The differences in distances of the bladder neck, cervix and pouch of Douglas to the pubococcygeal line (PCL) between supine and upright, were estimated together with changes in the genital hiatal area. Patients were scanned at rest and during straining. The data was analysed by one observer, with nine year of experience in abdominal radiology. The distances in the different situations were compared using the Wilcoxon ranking test. Results: Of the 15 datasets, one sagittal MRI dataset was of insufficient image quality and was excluded from analysis. Furthermore, one patient had no uterus, thus the PCL-cervix distance could not be determined. All mean distances to the PCL increased from supine-strain to upright-rest and from supine-strain to upright-strain position. These distances between difference positions changed as: the bladder descended 1.3 cm to 1.4cm; the cervix 1.1 cm to 2.2 cm and the pouch of Douglas 0.8 cm to 1.5 cm, respectively (all p-values < 0.05) (Figure 1). The hiatal area was larger in upright-strain position (mean 42.0 cm2; SD ±14.8) than during supine-strain position (mean 33.5 cm2; SD ±14.5), with a p-value of 0.02. Conclusion: Upright MRI scanning of patients with POP grade ≥ 2 at rest and during straining shows a significantly larger extent of the prolapse than what is observed during supine straining. In case of discrepancies between symptom severity and the observed prolapse stage, upright staging may be of use to establish the true extent of prolapse.