Dynamic magnetic resonance imaging for assessment of minimally invasive pelvic floor reconstruction with polypropylene implant

Abstract Introduction The purpose of the study was to assess the usefulness of dynamic MRI in patients with pelvic organ prolapse after pelvic floor repair with polypropylene mesh. Materials and methods Fifteen consecutive patients (mean age 66.5 years) who were scheduled for either anterior ( n = 9) or posterior ( n = 6) pelvic floor repair were prospectively evaluated by clinical assessment and dynamic MRI 1 day before and 3 months after surgery. MRI diagnoses and MRI measurements of relevant anatomical points at rest and on straining were analysed before and after surgery. Results At follow-up assessment 93.3% of all patients were clinically cured. Dynamic MRI showed newly developed ( n = 6) or increased ( n = 6) pelvic organ prolapse in 80% ( n = 12) of all patients 3 months after pelvic floor repair. Most of them ( n = 11; 91.7%) affected the untreated pelvic floor compartment. On straining anatomical points of reference in the anterior pelvic floor compartment were significantly ( p < 0.05) elevated after anterior repair and rectal bulging was significantly ( p = 0.036) reduced after posterior pelvic floor repair. Conclusions In this study dynamic MRI could verify the effective support of anterior and posterior pelvic floor structures by anterior and posterior polypropylene implant respectively. But dynamic MRI demonstrates if one compartment of the pelvic floor is repaired another compartment frequently (73.3%) develops dysfunction. These results did not correspond to clinical symptoms on short-term follow-up (3 months). Studies with long-term follow-up are necessary to prove if dynamic MRI can reliably identify clinically significant pelvic organ prolapse after pelvic floor repair before the onset of symptoms.