Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT.
OBJECTIVE
This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes.


METHODS
A total of 30 female patients with stress urinary incontinence (SUI), anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively.


RESULTS
In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines.


CONCLUSIONS
Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.
Palma
Paulo
P
Universidade Estadual de Campinas, Campinas, Sao Paulo, Brazil. ppalma@uol.com.br
Riccetto
Cassio
C
Fraga
Rogerio
R
Miyaoka
Ricardo
R
Prando
Adilson
A
D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D017773:Pelvic Floor / Q000033:anatomy & histology / Q000601:surgery*; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D053825:Suburethral Slings; D013526:Surgical Mesh; D036542:Tomography, Spiral Computed / Q000379:methods*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014596:Uterine Prolapse / Q000601:surgery*