Evaluation of Upright Magnetic Resonance Imaging in Female Genuine Stress Urinary Incontinence before and after MonarcR Bladder Neck Suspension: A Prospective Cohort Study

Abstract

Aim
Current methods used to assess patient suitability for bladder neck suspension prior to surgery are limited due to their inability to
examine patients in physiologic positions. The purpose of this study was to examine the usefulness of upright magnetic resonance
imaging (MRI) in the evaluation of patients with genuine stress urinary incontinence (GSUI) prior to undergoing Monarc^R bladder
neck suspension.
Materials and Methods
Twenty-seven female patients with known GSUI were selected to participate in the study. Each patient was asked to complete an
incontinence symptom score and then have 300 ml of sterile water instilled into their bladder. While standing in an upright MRI
scanner a T2-weighted image at 0.6 tesla was then obtained while at rest and then undergoing standardized Valsalva maneuver.
Special attention was then given to the downward movement of the H-line against the M-line. Measurements were taken to
determine excursion of the H-line against the M-line. The procedure was then repeated for each patient three-months after surgery.
The change in H-line excursion following surgery was compared to the change in symptom score using Spearman’s rank correlation
test.
Results
A positive correlation was found between the pre- and post-operative improvements in international consultation on incontinence
questionnaire female lower urinary tract symptoms modules (ICIQ-FLUTS) and the post-operative reduction of excursion of the
pelvic floor. These correlations were found to be statistically significant (p<0.001) using Spearman’s rank correlation test.
Conclusion
A greater degree of pelvic floor prolapse visible on magnetic resonance imaging (MRI) with a standardized Valsalva maneuver prior
to Monarc^R bladder neck suspension surgery predicts for better patient symptom score outcomes as determined by ICIQ-FLUTS.