Effect of a speculum blade on dynamic MRI evaluation of pelvic organ prolapse

We aimed to evaluate whether the use of a speculum blade modifies the evaluation of pelvic organ prolapse (POP) as assessed by dynamic magnetic resonance imaging (MRI). Twenty-seven women with POP Quantification (POPQ) stage II or greater, scheduled for POP surgery, were evaluated using MRI. The procedure was repeated using the posterior blade of a standard plastic Grave's speculum to successively retract the anterior and posterior vaginal walls. Standard POPQ was 15% stage II (n =4), 59% stage III (n =16) and 26% stage IV (n =7). The use of a blade evidenced hidden pelvic prolapsed compartments in 59% (n =16) of cases. For 48% of patients (n =13), the variation of the leading edge of at least one additional prolapsed compartment was diagnosed as more than 20 mm. In this series, the use of a speculum blade during dynamic MRI modified the POP evaluation in a large proportion of patients with POP stage ≥II.