Study Of Evaluation Of Dynamic MRI For Stress Urinary Incontinence And Stress Urinary Incontinence With Pelvic Organ Prolapse

Objective:To study the changes of pelvic floor of SUI and SUI with POP females according to the special angles and lines comparing with healthy females in the same age range depending on dynamic MRI. Attempt to conduct a preliminary evaluation of pelvic dynamic MRI in differential diagnosis for SUI and SUI with POP.Material and Methods:Nineteen females with stress urinary incontinence and fourty one females with stress urinary incontinence and pelvic organ prolapse were selected into this research between February2011and Jan2013according to clinical diagnosis. Fourty seven healthy females were choosen during the same time. Inclusion criteria. the healthy females should not accept any pelvic operation except cesarean delivery and haven’t underwent estrogen therapy, non SUI or POP. All the females with SUI or females with SUI and POP were subjected to a complete gynecology urology evaluation. The diagnostic criteria for stress urinary incontinence was recommended by ICS. The females with POP were evaluated adopting POP-Q. All the patients underwent pelvic MRI scan before accept treatment.Instruct patients to drink water with a comfortably filled bladder(200-300ml) half an hour before scanning and to practice the Valsalva maneuver. Standard MRI scans were taken in lithotomy position with phased array body coil by GE signal1.5T MRI. No contrast media in bladder.urethra, vagina or rectum. Dynamic magnetic imaging was performed at rest (FSE T2WI, TR4900ms,TE100ms, slice thick3mm, gap0.3mm, FOV24×24cm, NEX4, Matrix320×256) and at Valsalva maneuver(SSFSE T2WI, TR2000ms, TE80ms, slice thick5mm, gap1.0mm, FOV30cm×30cm, NEX0.56, Matrix288×256).Comparing with the healthy females, this study was aimed at researching the changing of the urethral lenth, posterior urethro-vesical angle, urethral tilt angel, a angle, levator hiatus width, diameter of diaphragm hiatus, M line, distance from the Sacrococcygeal-inferior pubic point line to bladder neck and to cervix in MRI of two different patient groups(SUI group and SUI+POP group). Statistical analysis was performed using SPSS v.12for Windows. Statistical description of data use the madian, P25and P75, which did not obey normal distribution. Kruskal-Wallis H test (taking P<0.05as statistically significant) and Mann-Whitney U test (taking P <0.017as statistically significant)were used to determine significant differences between the measured parameters.Results.1. The average ages for three groups have no statistical significance.2. The change of urethra support structure. the urethral length at rest have no statistical significance. The posterior urethro-vesical angle and urethral tile angle both are have statistical significance only between healthy females and SUI+POP females. The urethral length, the posterior urethro-vesical angle and urethral tile angle at valsalva maneuver of each two groups have statistical significance, which angles are bigger than that at rest of three groups.The a angle are no statistical difference between SUI group and SUI+POP group at both conditions.Althrough the bladder neck of both SUI group and SUI+POP group are lower than that of healthy females at rest, but there is no difference between SUI group and SUI+POP group in the same condition. The cervix neck of SUI females and healthy females are located above the horizon of the SCIPP line at rest and there is no difference of these two groups. The bladder neck and the cervix neck of each three groups in the valsalva maneuver condition are lower than what at rest. There is no statistical difference of the SCIPP-BN in SUI group and SUI+POP group, but SCIPP-C of each of three groups have statistical difference doing valsalva maneuver.3. The H line has no statistical difference only between SUI and SUI+POP females at rest,but has statistical difference in each two of three groups.The M line and levator hiatus width have statistical significance between healthy and SUI+POP females at rest. The H line, the levator hiatus width and the M line all have statistical difference between each two groups of three. But there is no difference of the levator plate angle in between each two groups of three in both two conditions.Conclusion:1.Pelvic dynamic MRI could display the pathologic changes of pelvic floor dysfunction, meanwhile have a certain value for differential diagnosis of stress urinary incontinence and stress urinary incontinence with pelvic organ prolapse. 2. The indicators that has helpful role in differential diagnosis of stress urinary incontinence and stress urinary incontinence with pelvic organ prolapse are urethral length, posterior urethro-vesical angle, urethral tilt angle, H line, levator hiatus width, M line, SCIPP-BN and SCIPP-C, in which the results during valsalva maneuver are especially important. But a angle and levator plate angle have some limited effectiveness.3.It could increase the reliability of the determination for function of pelvic floor combined using multiple indicators.