title: One-year dynamic MRI follow-up after vaginal mesh repair: evaluation of clinical, radiological, and quality-of-life results.
abstract: BACKGROUND
  Pelvic organ prolapse (POP) is a common disorder in elderly women often surgically repaired with alloplastic meshes; yet knowledge of the pelvic floor behavior and multi-compartment defects postoperatively is scarce.
  
  
  OBJECTIVE
  To evaluate the 1-year outcome after mesh repair in patients with POP using clinical examination (CE), dynamic magnetic resonance imaging (dMRI), and the prolapse quality-of-life (P-QOL) questionnaire.
  
  
  METHODS
  A prospective observational study was conducted of 69 women undergoing pelvic mesh surgery. Clinical examination, dMRI, and the P-QOL questionnaire were applied before and after surgery to evaluate POP. Mean outcome measures were POP outcome as determined on clinical and dMRI examinations and its impact on quality of life. Statistical results were obtained with SPSS version 15.0. ANOVA was used to compare pre-/postsurgical quality of life data.
  
  
  RESULTS
  Sixty-nine women (mean age, 64.75 years; BMI, 26.75 kg/m(2); postmenopausal, 89.2%) were recruited and treated with Seratom® or Perigee™ mesh implants. A significant improvement in the position of bladder neck, vaginal vault/uterus, pouch of Douglas, and rectum was found 12 weeks and 1 year after surgery using POP-Q scale and dMRI. Advanced cystoceles and enteroceles seem underestimated by CE using the POP-Q system compared to dMRI results (P = 0.003 and P < 0.001), vice versa dMRI overestimated POP compared to CE. Sixty-four women completed the P-QOL questionnaire, presenting reduced quality of life before surgery which improves postsurgically. Prolapse impact and physical, social, and role limitations correlated strongest with a low quality of life (P < 0.001).
  
  
  CONCLUSIONS
  The 1-year follow-up after mesh repair showed statistical and clinical improvement for all tools employed. dMRI seems a reliable tool for simultaneous assessment of defects in all three compartments, but tends to overestimate POP compared to clinical examination.
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany kerstin.brocker@med.uni-heidelberg.de.
authors.forename: Kerstin A
authors.initials: KA
authors.lastname: Brocker
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Heidelberg, Medical School, Heidelberg, Germany.
authors.forename: Celine D
authors.initials: CD
authors.lastname: Alt
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center of Postgraduate Education, Warsaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Rzepka
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Radiology Darmstadt, Alice-Hospital, Darmstadt, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hallscheidt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology*; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Magnetic resonance imaging (MRI); adults; pelvis; surgery; urinary