title: Dynamic magnetic resonance imaging of the pelvic floor in children and adolescents with vesical and anorectal malformations.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) of the pelvic floor allows better assessment of pelvic pathology and has a potential as an adjunct for therapy planning. In complex congenital malformations of the pelvic floor and continence organs, it plays a major role in assessing urinary and fecal incontinence or constipation, especially when performed as a dynamic investigation such as MRI defecography.
  
  
  METHODS
  Twenty-three patients (3-21 years old) with urinary and/or fecal incontinence or constipation attributable to congenital malformations of the pelvic region presented at our institution. The diagnoses were anorectal malformations (18), bladder exstrophy (2), and cloacal exstrophy (3). All patients underwent static and dynamic MRI of the pelvic floor with rest, squeeze, and evacuation in supine position.
  
  
  RESULTS
  Morphology and function of the pelvic floor and pelvic organs could be demonstrated in each case. The reason for urinary incontinence, fecal incontinence, or constipation could be defined, and an individual therapeutic management concept was made based upon the data obtained by the investigation.
  
  
  CONCLUSIONS
  The advantages of this method, in comparison to others, are direct visualization of the pelvic floor muscles and continence organs and their anatomical relationship during different functional actions. Pelvic floor dysfunction is often the reason for fecal and urinary incontinence and can be detected by MRI. Especially in children, minimizing radiation exposure is of major concern. Disadvantages are the costs and long investigation time.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Cologne, 50735 Köln, Germany. kinderchirurgie@kliniken-koeln.de
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Boemers
authors.forename: Barbara
authors.initials: B
authors.lastname: Ludwikowski
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Forstner
authors.forename: Christa
authors.initials: C
authors.lastname: Schimke
authors.forename: Mircia A
authors.initials: MA
authors.lastname: Ardelean
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000002:abnormalities* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000503:physiopathology; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D017773:Pelvic Floor; D012007:Rectum / Q000002:abnormalities* / Q000503:physiopathology; D001743:Urinary Bladder / Q000002:abnormalities* / Q000503:physiopathology; D014549:Urinary Incontinence / Q000503:physiopathology