Correlation of Symptom Relief with Degree of Anatomic Correction by Voiding Cystourethrography and MRI defecography after Surgical Correction of Incontinence and/or Pelvic Organ Prolapse
Goal 1: It is our aim to retrospectively correlate the degree of anatomic correction of the urethra and bladder, as determined by post-operative objective parameters using a standing voiding cystourethrogram (VCUG), with subjective improvement in symptoms and quality of life in women undergoing surgical repair of incontinence and/or pelvic organ prolapse. Patients who have undergone anterior vaginal wall suspension, urethral sling, or large cystocele repair have routinely been evaluated with VCUG pre- and post-operatively. These women have also routinely been evaluated with symptom and quality of life questionnaires.
Therefore, women who have undergone surgical repair of incontinence and/or pelvic organ prolapse from 1996 to 2011 will be evaluated retrospectively. Using measurements from pre- and post-operative VCUGs, and established radiographic criteria, patients will be classified into either an anatomy corrected group or not. These two groups will then be assessed for symptom and quality of life improvement using validated questionnaires (QoL, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, symptoms report, and physical examination findings). Need for secondary procedures to correct recurrent incontinence and/or prolapse will also be evaluated, along with supplemental post-operative therapy such as pelvic floor training exercises, bladder medications for overactive bladder, and injectable treatments to correct intrinsic sphincteric deficiency.
Goal 2: Urethral angles at rest and with straining, degree of cystocele, and presence of associated vaginal compartment prolapses will be studied by comparing data obtained by VCUG and pelvic MRI defecography. Furthermore, a comparison will be made between the clinical diagnosis and final surgical planning after the initial office visit and then following the MRI defecography. Because of its cost and limited availability so far, MRI defecography should be carefully scrutinized regarding its clinical relevance. Because the MRI is obtained several days or weeks after the initial office evaluation, recall bias will be eliminated. All MRI studies will be interpreted by two independent MRI radiologists, in whom intra-rater reading reliability will be measured by intra class correlation coefficient (ICC) with a goal of an accuracy rate of 80% or above. We hypothesize that the degree of bladder descent and urethral angle mobility will be consistently enhanced by supine MRI defecography over the findings of MRI with Valsalva or standing VCUG. We also hypothesize that the MD confidence in diagnosis will be significantly increased over the baseline office evaluation, and that surgical planning may be altered at least 25% of the time, thus justifying the utilization of this more costly modality in the pre-operative staging.
Subjects will include women who are a candidate for surgical repair of incontinence and/or pelvic organ prolapse at our institution with no restrictin on race or ethnic backgrounds. Since this condition affects only women, only females will be included. The subjects may range from 30 to 90 years of age at the time of surgery. Other concomitant treatments are allowable. Follow-up is per standard of care.