MRI of the female urethra and pelvic floor

Abstract

— MRI is the most powerful imaging procedure to visualize the structures of the pelvic floor. We have been interested in the use of MRI towards a better understanding of the pathophysiology of genuine stress incontinence due either to anatomical malposition of the pelvic viscera or to an intrinsically damaged urethra. Axial continuous images were obtained with T2 weighted spin-echo sequence in a total of 47 patients. In stress incontinent patients the urethra was usually more distant from the pubic bone than in normal controls. The urethro-pelvic ligaments were seen to extend downward in an oblique course. The levator sling was frequently deficient, usually thin or partially replaced by fat and connective tissue. In our experience, MRI provides information about the quality of the urethral wall and the pelvic floor. It is clearly superior to other radiological methods and will likely assume an even greater role in evaluating the urethra with paraurethral area and the female pelvis.