الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
 |  | from | 164 |  |  |
| | | from | 164 | | |
Abstract
Pelvic floor weakness is common in middle aged and elderly parous women and is often associated with stress incontinence, uterine prolapse, constipation, and incomplete defecation. Most patients with incontinence and minimal pelvic floor weakness can be treated based on physical examination and basic urodynamic findings. In women with symptoms of multicompartment involvement for whome a complex repair is planned or who have undergone previous repairs, magnetic resonance ( MR) imaging can be a useful preoperative planning tool. Advances in magnetic resonance imaging ( MRI) have made this technique an accurate imaging tool for the study of pelvic floor anatomy. Variations within MRI technology, such as the use of dynamic MR study, endovaginal/endorectal coils, openconfiguration MRI, and more recently,3D MRI, have improved the understanding of pelvic floor pathology. Other imaging techniques used before MRI have shown a number of problems: some are poorly tolerated by the patient or sometimes require the use of radiopaque contrast, or unable to visualize the entire pelvic floor. Dynamic MRI dose not involve ionizing radiation, is non invasive, dose not require patient preparation, and is relatively rapid technique that provide high quality images of soft tissue, clearly demonstrating the pelvic viscera displacement. Arguments against MRI are the lack of an accepted standardized imaging grading protocol for pelvic organs prolapse and MRI is relatively expensive as compared with clinical assessment. In these images the radiologist identifies the pubococcygeal line (which represent the level of the pelvic floor), the H and M lines (which are helpful for confirming pelvic floor laxity), and the angle of the levator plate with the pubococcygeal line (which is helpful for identifying small bowel prolapse). The use of upright imaging in an openconfiguration MR imaging maximize the evidence of all weakness and it rarely detects new defects or changes therapeutic approach. Three dimensional imaging has also been explored as a tool for determining levator ani volume, levator hiatus width, puborectalis muscle thickness, vaginal shape, bladder neck location, lateral pubovesical ligaments, posterior urethrovesical angle, and external anal sphincter features to select patient for either conservative therapy or surgery. In conclusion: MRI is the method of choice in diagnosis of pelvic floor weakness in women with symptoms of multicompartment involvement for whome a complex repair is planned or who have undergone previous repairs. MRI dose not involve ionizing radiation, is non invasive, dose not require patient preparation, and is relatively rapid technique that provide high quality images of soft tissue, clearly demonstrating the pelvic viscera displacement. Variations within MRI technology, such as the use of dynamic MR study, endovaginal/endorectal coils, openconfiguration MRI, and more recently,3D MRI, have improved the understanding of pelvic floor pathology.