title: MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence.
abstract: OBJECTIVE
  To evaluate pathomorphologic changes of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence (SUI) by MRI.
  
  
  METHODS
  Fifty-four women with SUI were examined by MRI (1.5T): body phased-array coil, axial and coronal proton-density-weighted sequences.
  
  
  RESULTS
  The urethral sphincter muscle showed a reduced thickness of its posterior portion (37%), an omega shape (13%) or higher signal intensity (50%); its abnormal configuration was associated with an increased signal intensity in 70% (p=0.001). The levator ani muscle comprised an unilateral loss of substance in 30%, a higher signal intensity in 28%, and altered origin in 19%. Central defects of the endopelvic fascia were present in 39% (n=21), lateral defects in 46%. There was a significant association between loss of the symphyseal concavity of the anterior vaginal wall and lateral fascial defects (p=0.001) and levator ani changes (p=0.016).
  
  
  CONCLUSIONS
  MRI yields findings supporting current theories on the pathogenesis of SUI.
authors.affiliation: Department of Gynecology and Obstetrics, Charité Medical School, Humboldt-Universität zu Berlin, Germany. r.tunn@alexius.de
authors.forename: Ralf
authors.initials: R
authors.lastname: Tunn
authors.forename: Kathrin
authors.initials: K
authors.lastname: Goldammer
authors.forename: Jörg
authors.initials: J
authors.lastname: Neymeyer
authors.forename: Annett
authors.initials: A
authors.lastname: Gauruder-Burmester
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Dirk
authors.initials: D
authors.lastname: Beyersdorff
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D005205:Fascia / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017773:Pelvic Floor / Q000473:pathology*; D014521:Urethra / Q000473:pathology*; D014550:Urinary Incontinence, Stress / Q000473:pathology*