Global pelvic floor descent during evacuation

Case contributed by Dr Vikas Shah

Presentation

Mixed stress and urge urinary incontinence. Vaginal discomfort. Difficult defaecation.

Patient Data

Age: 35
Gender: Female
Modality: MRI

Trans-vaginal tape (TVT) is seen on the axial and coronal images as linear low signal structures extending from the lower anterior abdominal wall, passing posterior to the bladder neck.

The dynamic images reveal:

  • a moderate degree of global pelvic floor descent
  • a moderate sized anterior rectocoele
  • no rectoanal mucosal intussusception or external prolapse
  • a moderate sized cystocoele and reduction of vesico-urethral angle in keeping with urethral hypermobility

Case Discussion

The presence of the TVT reflects a previous attempt at treating the stress urinary incontinence. However there is marked descent of the urinary bladder on evacuation, and this with the change in urethral angle are anatomical changes that contribute to stress incontinence. There is also rectal descent along with a rectocoele. The imaging findings can explain all of the symptoms.

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Case Information

rID: 49262
Case created: 17th Nov 2016
Last edited: 5th Jan 2017
Inclusion in quiz mode: Included

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