The application of MR defecography in assessing bladder and urethral function pre and post-operatively in patients with moderate to severe pelvic organ prolapse.

PURPOSE: The objective was to offer imaging-based evidence to analyze the functional changes in the bladder and urethra associated with pelvic floor reconstruction.

METHODS

The study included patients with grade II or higher pelvic organ prolapse (POP). The primary analysis involved comparing changes in the function parameters before and after pelvic reconstruction. Secondly, patients were divided into two groups: those who had pelvic floor reconstruction combined with a mid-urethral sling (MUS) and those without MUS. The impact of combining MUS on changes in bladder and urethral functions was then compared.

RESULTS

Forty-three patients were included in the study. 5 of the 43 enrolled patients refused postoperative MRD and were excluded from paired analysis. Compared with the preoperative measurements, the urethral length (2.28 cm ± 0.82 cm vs. 1.95 cm ± 0.54 cm) and urethral angle (103.60° ± 65.02° vs. 52.75° ± 27.40°) decreased significantly after surgery. The bladder-urethral angle (97.20° ± 35.10° vs. 134.80° ± 31.27°) and the incidence of bladder funneling (21.05% vs. 44.74%) increased postoperatively. Secondly, 20 patients who had undergone isolated POP repair compared with 18 patients who had undergone POP repair combined with MUS. A statistically significant increase in the incidence of bladder funneling was observed in the isolated POP repair group (20.00% vs. 50.00%, p = 0.047).

CONCLUSION

Pelvic floor reconstruction with or without a MUS, consistently resulted in significant improvements in the anatomical positions of the pelvic organs within 3-6 months of the surgery. The incidence of bladder funneling increased after surgery indicates that the weakness at the urethro-vesical junction becomes more pronounced.