MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence.
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.
Tunn
Ralf
R
Department of Gynecology and Obstetrics, Charité Medical School, Humboldt-Universität zu Berlin, Germany. r.tunn@alexius.de
Goldammer
Kathrin
K
Neymeyer
Jörg
J
Gauruder-Burmester
Annett
A
Hamm
Bernd
B
Beyersdorff
Dirk
D
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*