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Global pelvic floor descent during evacuation

Case contributed by Vikas Shah , 17 Nov 2016
Diagnosis probable
Changed by Vikas Shah, 12 Aug 2020

Updates to Study Attributes

Findings was changed:

Trans-vaginal tape (TVTStructural findings:Unremarkable appearances of the urinary bladder, vagina, uterus, ovaries, anal canal and rectum. No evidence of endopelvic fascial defect. TVT (tension free transvaginal) tape is seenidentified on the axial and coronal images as linear low signal structures extending from the lower anterior abdominal wall, passing posterior to the bladder neck. Symmetric appearances of the levator musculature. No lymphadenopathy and no bony abnormality.

The dynamic images revealDynamic findings:Measurements obtained using the PCL system at maximal straining are as follows:Bladder neck: 37 mm below line (mild cystocele)Uterine cervix: 12 mm below line (mild uterine descent)Anorectal junction: 63 mm below line (moderate anorectal junction descent)Anterior rectocele: 36 mm in depth (moderate sized anterior rectocele)

  • a moderate degree

    At the onset of evacuation, there is marked global pelvic floor descent

  • . As the rectal gel is evacuated from the lumen, the posterior portion of the cystocele is allowed to enlarge and forms a relatively broad base compressing the anterior wall of the vagina. The gel within the rectocele is not expelled, but there is no significant rectal mucosal thickening and no intussusception or external prolapse. The angle between the bladder neck and urethra changes markedly during evacuation, in keeping with the clinical finding of urethral hypermobility. No definite loss of urine was observed during the study. There is no enterocele.

    In summary:No structural abnormality.Moderate global pelvic floor descent, with the anterior and posterior compartments being the worst affected, with

    moderate sized anterior rectocoele
  • norectocele.No rectoanal mucosal intussusception or external prolapse
  • a moderate sized cystocoele and reduction.Reduction of vesico-urethral angle during evacuation in keeping with urethral hypermobility
.

Updates to Case Attributes

Body was changed:

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 rectocoelerectocele. The imaging findings can explain all of the symptoms.

  • -<p>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.</p>
  • +<p>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 rectocele. The imaging findings can explain all of the symptoms.</p>

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