PD44-01: Is there an added value for dynamic MRI of the pelvic floor, to the Clinical POP-Q Examination before management of Pelvic Organ Prolapse in females: A double blinded prospective study in a tertiary care center

Ahmed Fathy Hussein*, Ranya Farouk Elsayed, Noha Mahfouz, Ahmed Yehya Abdelziz, Amr Mostafa Zahran, Hussein Ali Hussein, Mohamed Salah Abdel Azim, Cairo, Egypt

Introduction: Vaginal examination is currently the cornerstone of diagnosis of Pelvic Organ Prolapse (POP),but it may miss or downgrade POP thus missing a surgical treatment. Examples are uncooperative, anxious, obese patients or those with narrow introitus. According to the literature, dynamic MRI is deemed to be accurate in POP grading, however, limitations may alter the MRI results. For instance, the patient may not attain the maximal strain during the dynamic test; either due to claustrophobia, or non-compliance or misunderstanding the instructions. We tried to compare both methods and show the degree of concordance and any added benefit of using MRI.

Methods: This is a double blinded prospective controlled study (urologists and radiologists were blinded to each other) over 2 years including 34 cases complaining of mixed urinary incontinence with variable degrees of POP. Patients underwent detailed history, POP-Q examination and dynamic MRI. Sugical intervention was done (classical vaginal repair with or without mid-urethral sling / laparoscopic sacrocolpopexy) based on the clinical examination only, blinded to the pre-operative MRI.

Results: Regarding the anterior compartment; all patients(100%) had Grade 2 or more anterior prolapse (n=34). Agreement (in detecting the same accurate grade) occurred in 25/34 patients(73.5%). MRI downgrading occurred in 6 patients(17.6 %) compared to clinical grading where 2 of them(5.9 %) were only diagnosed clinically and missed by the MRI. In these 6 cases, surgical intervention was done and the patients significantly improved. On the other hand; clinical downgrading occurred in one patient(2.9 %)(the MRI showed grade 3 POP while clinically grade 2) and patient was managed surgically.

Regarding the posterior compartment; agreement occurred in 23/34 patients(67.6%), MRI downgrading occurred in 6 cases(17.6 %). MRI missed 1 case(2.9 %) which was only diagnosed clinically. On the other hand; clinical examination downgraded  2 cases(5.8 %) and missed 4 cases(11.76%) which were diagnosed by the MRI. All the patients with clinically missed or downgraded posterior prolapse were asymptomatic, so this did not change the clinical decision.

Conclusions: There is significant agreement (67-88 %) between dynamic MRI and clinical POP-Q examination in POP grading. Despite the clinically missed POP cases (or downgraded) after retrospectively reading the pre-operative MRI, they were mild and this did not seem to change the clinical decision.

Source of Funding: non