CT Pelvis Although CT may be used for the evaluation of patients that present with acute complications after surgical repair, to our knowledge, there is no relevant literature that supports use of CT for routine assessment or initial imaging of patients with subacute or chronic complications of pelvic floor repair. CT can demonstrate certain urethral bulking agents (when calcified), retropubic arms and bone anchors of urethral slings, and sacrocolpopexy mesh as it courses from the vaginal apex to the sacral promontory [100,107]; however, the poor inherent soft-tissue resolution of CT makes visualization of synthetic materials challenging compared with MRI. The synthetic materials along the anterior and posterior vaginal walls are also not depicted well on CT. Fluoroscopy Voiding Cystourethrography VCUG can be used as an objective measure of change in cystocele height and urethral angle after surgical repair [14]. Although VCUG can be used to assess for urinary dysfunction in the postoperative setting, it is not able to directly depict pelvic floor musculofascial structures. Patients that present with new voiding dysfunction or chronic urinary tract infections after surgery may be assessed with VCUG. In the setting of severe voiding dysfunction, the urethra may not opacify, thus limiting evaluation. In other cases, there may be narrowing of the voiding urethra, a secondary sign to suggest urethral obstruction due to implanted sling or other material. Indirect findings of voiding dysfunction, such as a trabeculated bladder, and large postvoid bladder residual may be seen. In most cases, other anatomic changes after surgery, including implanted surgical material, may not be directly visible on fluoroscopy. MRI Defecography MR defecography includes both an anatomic and functional evaluation of the pelvic floor. It is used to evaluate patients with suspected postsurgical complications if there is concomitant concern for persistent recurrent POP or other pelvic floor dysfunction.
Pelvic Floor Dysfunction in Females. CT Pelvis Although CT may be used for the evaluation of patients that present with acute complications after surgical repair, to our knowledge, there is no relevant literature that supports use of CT for routine assessment or initial imaging of patients with subacute or chronic complications of pelvic floor repair. CT can demonstrate certain urethral bulking agents (when calcified), retropubic arms and bone anchors of urethral slings, and sacrocolpopexy mesh as it courses from the vaginal apex to the sacral promontory [100,107]; however, the poor inherent soft-tissue resolution of CT makes visualization of synthetic materials challenging compared with MRI. The synthetic materials along the anterior and posterior vaginal walls are also not depicted well on CT. Fluoroscopy Voiding Cystourethrography VCUG can be used as an objective measure of change in cystocele height and urethral angle after surgical repair [14]. Although VCUG can be used to assess for urinary dysfunction in the postoperative setting, it is not able to directly depict pelvic floor musculofascial structures. Patients that present with new voiding dysfunction or chronic urinary tract infections after surgery may be assessed with VCUG. In the setting of severe voiding dysfunction, the urethra may not opacify, thus limiting evaluation. In other cases, there may be narrowing of the voiding urethra, a secondary sign to suggest urethral obstruction due to implanted sling or other material. Indirect findings of voiding dysfunction, such as a trabeculated bladder, and large postvoid bladder residual may be seen. In most cases, other anatomic changes after surgery, including implanted surgical material, may not be directly visible on fluoroscopy. MRI Defecography MR defecography includes both an anatomic and functional evaluation of the pelvic floor. It is used to evaluate patients with suspected postsurgical complications if there is concomitant concern for persistent recurrent POP or other pelvic floor dysfunction.