title: [Vaginal prolapse. What dynamic pelvic MRI adds to clinical examination?].
abstract: OBJECTIVE
  We wanted to study the role of dynamic pelvic MRI (D-MRI) in the surgical management of patients with genito-urinary prolapse.
  
  
  METHODS
  A routine D-MRI examination before and after laparoscopic double promontofixation was performed in 15 cases with symptomatic vaginal prolapse in need of surgical treatment. The review included also three self-administered questionnaires of symptoms and quality of life. We compared the preoperative clinical evaluation of the studied cases with D-MRI data. Changes after the surgical treatment were also studied.
  
  
  RESULTS
  The D-MRI provides an accurate diagnostic evaluation of the pelvis, which is both objective and reproducible. The correlation between clinical scores and radiological magnetic resonance was 53.3% only. In cases with absence of previous pelvic surgery, there was a radio-clinical discrepancy of 40% of cases, while in cases with history of a previous pelvic surgery we found a discrepancy of 60% of cases. This was due to clinical difficulty in differentiating between peritoneocele and rectocele, or due to under-diagnosis of complex prolapse. The sensitivity of MRI in the diagnosis of cystocele, hysterocele and rectocele were respectively 100, 100 and 83%. The gain in sensitivity provided by the MRI was significant for the diagnosis of peritoneocele: 100% against 33%. The specificity was 100%. Static images allowed a detailed study of damaged connective tissues and pelvic muscles.
  
  
  CONCLUSIONS
  The D-MRI seems an appropriate tool in pre-operative assessment of cases with vaginal prolapse. It will help in focusing our surgical strategy, especially in cases that present post-hysterectomy and in cases with residual or recurrent prolapse.
authors.affiliation: Service d'Urologie, Nouvel Hôpital Civil, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France. obringerl@yahoo.fr
authors.forename: L
authors.initials: L
authors.lastname: Obringer
authors.forename: C
authors.initials: C
authors.lastname: Roy
authors.forename: P
authors.initials: P
authors.lastname: Mouracade
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Jacqmin
authors.forename: C
authors.initials: C
authors.lastname: Saussine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010808:Physical Examination; D014596:Uterine Prolapse / Q000175:diagnosis*