title: Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI?
abstract: OBJECTIVE
  This study seeks to quantify differences in anterior vaginal wall prolapse during sequential Valsalva attempts on dynamic magnetic resonance imaging (MRI).
  
  
  METHODS
  Subjects were taken from an on-going case-control study evaluating anterior vaginal wall prolapse. Women with a prolapse whose leading edge extended >or=1 cm beyond the hymenal ring were included (n = 40). All subjects performed three maximal Valsalva efforts while mid-sagittal dynamic MRI scans were obtained. Bladder descent between the first, second, and third maximal Valsalva efforts were compared.
  
  
  RESULTS
  Forty percent of women had a greater than 2-cm increase in prolapse size from their first to third Valsalva attempt. Ninety-five percent of women extended their prolapse further with a third Valsalva.
  
  
  CONCLUSIONS
  As is true during clinical examination, several attempts may be required to have maximal anterior compartment prolapse present during dynamic MRI of the pelvic floor.
authors.affiliation: Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA. jtumbare@umich.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Tumbarello
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hsu
authors.forename: Christina
authors.initials: C
authors.lastname: Lewicky-Gaupp
authors.forename: Suzan
authors.initials: S
authors.lastname: Rohrer
authors.forename: John O L
authors.initials: JO
authors.lastname: DeLancey
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000503:physiopathology*; D014636:Valsalva Maneuver