title: Restoration of continence by pessaries: magnetic resonance imaging assessment of mechanism of action.
abstract: OBJECTIVE
  The objective of the study was to determine incontinence pessaries' mechanism of action by measuring changes on urodynamic studies (UDS) and dynamic magnetic resonance imaging (MRI) with and without pessaries in place.
  
  
  METHODS
  Women with stress incontinence had UDS and MRI performed with and without incontinence dish pessaries.
  
  
  RESULTS
  Fifteen women were evaluated. Pessary insertion resulted in increased urethral resistance; detrusor pressures increased (33-45 cm H(2)O) and maximal flow rates decreased (30 to 19 mL/second). With Valsalva on MRI, pessaries were associated with decreased posterior urethrovesical angles (175-130 degrees), bladder neck elevation (0.3 below to 0 .8 cm above the pubococcygeal line) and increased urethral lengths (2.4 to 2.97 cm). Bladder neck funneling with cough occurred in 14 patients without pessaries and 3 with pessaries.
  
  
  CONCLUSIONS
  On UDS and MRI following pessary placement, continence restoration was associated with decreased posterior urethrovesical angles, bladder neck descent and funneling, and increased urethral lengths and resistance to urine flow.
authors: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors: Yuko M
authors: YM
authors: Komesu
authors: Loren H
authors: LH
authors: Ketai
authors: Rebecca G
authors: RG
authors: Rogers
authors: Steven C
authors: SC
authors: Eberhardt
authors: Jennifer
authors: J
authors: Pohl
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010570:Pessaries; D020127:Recovery of Function; D014521:Urethra / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000503:physiopathology*; D014563:Urodynamics