This variant focuses on initial imaging evaluation of patients with subacute or chronic complications of pelvic floor repair, often with biological or synthetic graft materials, rather than acute perioperative complications, recurrent prolapse or other recurrent pelvic floor dysfunction. Imaging for evaluation of recurrent prolapse or other recurrent pelvic floor dysfunction follows the same appropriateness criteria as for primary pelvic floor dysfunction in Variants 1 thru 3 described above. Imaging can complement clinical evaluation in patients that present with subacute or chronic complications after pelvic floor surgery [100]. Evaluation may be complicated by multiple prior procedures with limited access to previous surgical details. The lifetime risk of undergoing a surgical procedure for POP or UI in the US is 11%, and the reoperation rate is as high as 29% [7]. Reconstructive surgical treatments for POP or UI include primary surgical repair of native tissues, repair with biologic or absorbable grafts, placement of synthetic implants such as urethral slings, vaginal mesh or bulking agents, and vaginal wall or bladder-neck suspension procedures. Potential subacute or chronic complications of POP repair with mesh material include contraction or shrinkage, mesh exposure through a mucosal surface, or mesh extrusion out of the body cavity [101-104]. Patients may thus present with pelvic or groin pain, infection, voiding dysfunction, or pain/dyspareunia due to improper positioning or migration of synthetic materials or from excessive scarring. Functional complications of pelvic floor surgery include devascularization and denervation leading to voiding dysfunction, persistent pain, and dyspareunia [105,106].
Pelvic Floor Dysfunction in Females. This variant focuses on initial imaging evaluation of patients with subacute or chronic complications of pelvic floor repair, often with biological or synthetic graft materials, rather than acute perioperative complications, recurrent prolapse or other recurrent pelvic floor dysfunction. Imaging for evaluation of recurrent prolapse or other recurrent pelvic floor dysfunction follows the same appropriateness criteria as for primary pelvic floor dysfunction in Variants 1 thru 3 described above. Imaging can complement clinical evaluation in patients that present with subacute or chronic complications after pelvic floor surgery [100]. Evaluation may be complicated by multiple prior procedures with limited access to previous surgical details. The lifetime risk of undergoing a surgical procedure for POP or UI in the US is 11%, and the reoperation rate is as high as 29% [7]. Reconstructive surgical treatments for POP or UI include primary surgical repair of native tissues, repair with biologic or absorbable grafts, placement of synthetic implants such as urethral slings, vaginal mesh or bulking agents, and vaginal wall or bladder-neck suspension procedures. Potential subacute or chronic complications of POP repair with mesh material include contraction or shrinkage, mesh exposure through a mucosal surface, or mesh extrusion out of the body cavity [101-104]. Patients may thus present with pelvic or groin pain, infection, voiding dysfunction, or pain/dyspareunia due to improper positioning or migration of synthetic materials or from excessive scarring. Functional complications of pelvic floor surgery include devascularization and denervation leading to voiding dysfunction, persistent pain, and dyspareunia [105,106].