Medičnì Perspektivi (Jun 2013)
Possibilities of magnet-resonance tomography usage while examining patients with reccurent genital prolapse
Abstract
Complex problem of establishing a diagnosis and choosing optimal treatment for patients with recurrent genital prolapse calls for improving preoperative clinical examination of these patients. Relapse necessitates better understanding of genital prolapse in each individual patient. The results of survey of 45 women with recurrent genital prolapse at the stage of preparation for re-surgery using magnetic resonance imaging are submitted. Follow-up period was 4 years. Dynamic study of the pelvic fundus was performed by a radiologist using MRI Philips Intera 1,5 Tesla with the possibility of 3D modeling, making up to 1mm thick slices in any plane, high differentiation of soft tissue (ligaments, muscles). The study showed that the classification of prolapse by stages is useful for standardization of diagnosis, but it is less useful for a differentiated approach to the choice of surgical strategy, since it ignores the nuances of surgical anatomy. The developed algorithm of dynamic magnetic resonance imaging in patients with recurrent pelvic hernia significantly improves the quality of diagnosis. It takes into account the relationship between the segments and allows to evaluate the type of fascial and ligament complex defect, the details of planning future surgery. In 57,8% of patients prolapse of the vagina following pubo-coccygeal line indicates a true relapse. Reducing the distance while performing Valsalva samples from cervical pubo-coccygeal line 2-3 cm was seen as second-best result of the operation – 26,7%, questionable form of recurrence was observed in 15,6% of patients. The developed algorithm makes it possible to determine the extent of the procedure and to predict possible intraoperative complications and results of operations, to avoid changes of operation plan, to minimize the risk of recurrence and the need for re-surgery. In the postoperative period it allows to determine topographical relations between pelvic organs and quality of prosthesis adjustments. Magnetic resonance diagnosis, compared with other methods of research, is harmless to the patient and is not restricted plane of the study, that makes it possible to use it both for objective diagnosis and dynamic follow-up during treatment in operative gynecology.
