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Evaluation of the effect of abdominal sacrocolpopexy (ASC) on urethral anatomy and continence mechanism using dynamic MRI

  • Urology - Original Paper
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Abstract

Introduction

Treatment of pelvic organ prolapse (POP) associated with stress urinary incontinence (SUI) is a surgical challenge. Surgeons may perform combined prolapse and incontinence surgery or may correct prolapse first and evaluate incontinence afterwards. We present a prospective study to evaluate the effect of abdominal sacrocolpopexy (ASC) on urethral anatomy and continence using dynamic magnetic resonance imaging (MRI).

Methods

Twenty females with concomitant apical prolapse and SUI due to urethral hypermobility were included. Patients with intrinsic sphincteric deficiency (ISD) were excluded. All patients underwent ASC operation as a sole treatment without anti-incontinence procedure. Patients were informed they may need anti-incontinence procedure afterwards. Symptom-specific questionnaires assessing prolapse, incontinence, sexual function and quality of life (QoL), dynamic MRI and pressure flow urodynamic study were administered before and after surgery.

Results

Mean age was 53 years. All patients had apical prolapse; four with cystocele, and five with rectocele. Urethral hypermobility was positive in all patients. After performing ASC, all patients reported significant improvement of all prolapse and incontinence questionnaires as well as QoL and sexual function. Significant improvement of incontinence parameters on dynamic MRI (bladder neck descent, posterior urethrovesical angle and urethral inclination angle) was observed after ASC. Similarly, significant change in the position of the leading edge of prolapse and anorectal junction was observed.

Conclusions

In patients with prolapse and urethral hypermobility, ASC may return bladder neck and urethral anatomy towards normal as proved by dynamic MRI. However, further studies on larger number of patients with longer follow-up period are required.

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Authors and Affiliations

  1. Section of Voiding Dysfunction and Female Urology, Urology Department, Faculty of Medicine, Alexandria University, Azarita, Alexandria, 21113, Egypt

    Wally Mahfouz, Mostafa Elmissiry, Saif-Alislam Gomaa & Ashraf Koraitim

  2. Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Hebatallah Hassan

Authors
  1. Wally Mahfouz
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  2. Mostafa Elmissiry
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  3. Saif-Alislam Gomaa
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  4. Ashraf Koraitim
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  5. Hebatallah Hassan
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Contributions

WM: project development, performing procedure, manuscript writing. ME: performing procedure, manuscript writing. S-AG: data collection, patient evaluation. AK: manuscript writing, project development. HH: performing procedure, project development.

Corresponding author

Correspondence to Mostafa Elmissiry.

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Conflict of interest

Wally Mahfouz, MD declares that he has no conflict of interest. Mostafa Elmissiry, MD declares that he has no conflict of interest. Saif-Alislam Gomaa, MD declares that he has no conflict of interest. Ashraf Koraitim, MD declares that he has no conflict of interest. Hebatallah H.M. Hassan, MD declares that she has no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee of Alexandria University, Egypt, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mahfouz, W., Elmissiry, M., Gomaa, SA. et al. Evaluation of the effect of abdominal sacrocolpopexy (ASC) on urethral anatomy and continence mechanism using dynamic MRI. Int Urol Nephrol 52, 1429–1435 (2020). https://doi.org/10.1007/s11255-020-02444-8

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  • DOI: https://doi.org/10.1007/s11255-020-02444-8

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