Evaluation of Upright Magnetic Resonance Imaging in Female Genuine Stress Urinary Incontinence before and after MonarcR Bladder Neck Suspension: A Prospective Cohort Study

*Corresponding author: Simon Treissman*, Richard Brownlee, Robert Colistro, Mark Treissman, Jennifer Kozic, Lee Jonat, Stephen Faddegon, Marg Querin and Erin Goode,

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original research

Abstract

Aim

Current methods used to assess patient suitability for bladder neck suspension prior to surgery are limited due to their inability to examine patients in physiologic positions. The purpose of this study was to examine the usefulness of upright magnetic resonance imaging (MRI) in the evaluation of patients with genuine stress urinary incontinence (GSUI) prior to undergoing MonarcR bladder neck suspension.

Materials and Methods

Twenty-seven female patients with known GSUI were selected to participate in the study. Each patient was asked to complete an incontinence symptom score and then have 300 ml of sterile water instilled into their bladder. While standing in an upright MRI scanner a T2-weighted image at 0.6 tesla was then obtained while at rest and then undergoing standardized Valsalva maneuver. Special attention was then given to the downward movement of the H-line against the M-line. Measurements were taken to determine excursion of the H-line against the M-line. The procedure was then repeated for each patient three-months after surgery. The change in H-line excursion following surgery was compared to the change in symptom score using Spearman’s rank correlation test.

Results

A positive correlation was found between the pre- and post-operative improvements in international consultation on incontinence questionnaire female lower urinary tract symptoms modules (ICIQ-FLUTS) and the post-operative reduction of excursion of the pelvic floor. These correlations were found to be statistically significant (p<0.001)  using Spearman’s rank correlation test.

Conclusion

A greater degree of pelvic floor prolapse visible on magnetic resonance imaging (MRI) with a standardized Valsalva maneuver prior to MonarcR bladder neck suspension surgery predicts for better patient symptom score outcomes as determined by ICIQ-FLUTS.

Keywords

Magnetic resonance imaging (MRI); Bladder neck suspension; Stress urinary incontinence.