Impact of MRI Defectography on Surgical Approach in Patients with Pelvic Floor Dysfunction

Background: Surgical treatment of pelvic floor dysfunctions carries frequent recurrences. The aim of the study was to evaluate the role dynamic MRI defecography in demonstrating the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients to guide surgical approach and minimize failure. Methods: Patients underwent perineal examination, conventional defecography, anorectal manometry, colonoscopy, and MRI defecography. The different pelvic floor morphologies were recorded. The type of treatment, whether conservative or surgical, was also recorded. Results: In total, 33 patients were included, with mean age 46.78 ± 10.51 years and the majority (69.7 %) of patients were female. 31 patients (93.9 %) with perineal descent, 21 patients (63.6 %) with rectoceles , 19 patients (57.57 %) with cystoceles, 4 patients (12.1 %) with enteroceles, 15 patients (45.4 %) with intussusceptions, 14 patients (42.2 %) with uterine prolapse and 12 patients with dyskinetic puborectalis muscle. The findings of dynamic MRI defecography were consistent with clinical results in 54.54 % with additional diagnostic parameters in 45.45 % of patients. Dynamic MRI findings changed treatment decision in 15 (45.5 %) patients with surgical treatment performed in 21 patients (63.6 %) and conservative treatment in 12 patients (36.3 %). Conclusion: Dynamic MRI defecography represents an essential diagnostic procedure in females and to a lesser extent in males, especially in terms of dynamic imaging of the pelvic floor organs during defecation. In addition to the clinical assessment, dynamic MRI defecography had clinical impact in pelvic floor dysfunction and interdisciplinary treatment decisions