Clinical examination and dynamic magnetic resonance imaging in vaginal vault prolapse

OBJECTIVE: To estimate the role of dynamic magnetic resonance imaging MRI as a diagnostic tool in die evaluation of vaginal apex prolapse in women with previous hysterectomy. METHODS: Clinical examinations were performed on 51 women presenting with symptoms of prolapse. A preoperative dynamic MRI assessment was performed. The mid pubic line was the reference level used for prolapse grading. The parameters of analysis included 1) correlation by compartments of clinical and MRI grading of prolapse, 2) assessment of the accuracy of clinical examination of the middle compartment, and 3) identification of any additional information provided by MRI. All MRI films were analyzed and validated by the same two observers. RESULTS: Analysis of each compartment separately revealed poor correlation between clinical and MRI assessment. Of the 51 cases with clinical vault prolapse, 27 (52.9%) cases were clinically overdiagnosed, 3 (6%) were underdiagnosed, and there was agreement in 21 (41.1%) when compared with MRI findings. Postoperative follow-up of the 18 (85%) patients who underwent colposacropexy after intraoperative assessment revealed the presence of cystocele in 4 (26.6%) occasions and rectocele in 3 (20%), which had been detected on MRI but not confirmed intraoperatively. CONCLUSION: There is poor correlation between clinical and MRI findings when assessing vaginal apex prolapse. Magnetic resonance imaging allows the identification of other prolapsing compartments and may be a complementary diagnostic tool for the diagnosis of complex vaginal apex prolapse. (C) 2004 by The American College of Obstetricians and Gynecologists.