To evaluate the role of Magnetic Resonance Imaging (MRI) in women presenting with suspected implant complications following surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI).
Retrospective single-centre cohort study in a designated tertiary referral centre. All women with vaginally and/or abdominally placed implants for POP or SUI who were referred with suspected mesh complications, and investigated with an MRI scan, between January 2018-October 2020 were included in the study.
97 women were identified over this time-period with a total of 123 implants, a median age of 55 years (Range: 34-79) and an average insertion to presentation time of 84 months (Range: 2-300). 78% (74) had one implant in situ, with the remainder having at least 2 in situ. Transobturator tapes (TVT-O/TOT) were the most common implants [35% (43)]. Chronic Pelvic or abdominal pain was the most common clinical symptom [73.2% (71/112 primary complaints)] with provoked tenderness on examination being the most common clinical finding [27.8% (32/115 clinical findings)]. MRI was more likely to detect abdominally placed implants [100% (all 30)] and Retropubic Tapes [89% (16/18)] when compared to Transvaginal POP implants [87.5% (28/32)] and TVT-O/TOT [67% (29/43)]. MRI identified both cases of Sacrocolpopexy mesh rupture as well as all 11 cases of infection (100%). In 91% (10/11) of these cases, MRI revealed the infection to be more widespread than clinical findings initially suspected. Cohen's Kappa demonstrated excellent correlation between MRI and surgical findings in cases with implant related infection, rupture and normal findings (κ = 1; z = 4.58; p = 0.00000459).
MRI can be a useful tool in assessment and management of patients with complications from implants. MRI can detect infection that may be more extensive that is initially clinically apparent in the outpatient setting. Abdominal implants appear to be easier to detect than transvaginal meshes and trans obturator tapes.
European journal of obstetrics, gynecology, and reproductive biology. 2022 Apr 01 [Epub ahead of print]
Priyanka H Krishnaswamy, Vijna Hiteshna Boodhoo, Joanna McNeil, Veenu Tyagi, Karen Lesley Guerrero
Subspecialty Registrar in Urogynaecology, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom. Electronic address: ., Core Surgical Trainee, Department of General Surgery, Barnsley Hospital, Gawber Road, Barnsley S75 2EP, United Kingdom., Consultant Radiologist, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom., Subspecialist Urogynaecology Consultant, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom.