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Erschienen in: Current Bladder Dysfunction Reports 3/2021

31.05.2021 | Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)

Contemporary Review of MRI in Benign Genitourinary Pelvic Medicine: What Every Urologist Should Know

verfasst von: Darshil Choksi, Bradley Schott, Khue Tran, Rose Khavari

Erschienen in: Current Bladder Dysfunction Reports | Ausgabe 3/2021

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Abstract

Purpose of Review

Herein we report a systematic review of literature to identify the contemporary focus areas of magnetic resonance imaging (MRI) use in benign Urology and present the highest yield results.

Recent Findings

MRI, specifically upright MRI, in combination with proper instructions and repeated Valsalva maneuvers, allows for more objective assessment of pelvic organ prolapse (POP) staging. The lack of standardization of reference lines and points used in MRI evaluation of POP is a key limitation. Evaluation of prostate artery embolization (PAE) as an effective treatment for benign prostatic hyperplasia (BPH) was a key focus of recent studies, but clear data regarding ideal patient population, procedure standardization, and performance compared to TURP are still lacking. A longer membranous urethral length (MUL) measured on MRI was predictive of post-prostatectomy continence. Dynamic MRI of the vesicourethral junction provided insight into the development of stress urinary incontinence (SUI) and the factors that contribute to successful treatment with a sling. Functional MRI demonstrated that localization of the defective signaling mechanism in women with overactive bladder (OAB) determines their likelihood to respond to pelvic floor muscle training. Patients with both neurogenic and non-neurogenic LUT dysfunction show abnormalities in both grey and white brain matter compared to healthy individuals, especially in the pontine micturition center and periaqueductal grey.

Summary

MRI has become an indispensable tool in benign Urology with its applicability in diagnosis, prediction, and prognosis of the disease at the organ level (bladder, prostate, urethra) and beyond (brain).
Literatur
1.
Zurück zum Zitat Damadian R, Zaner K, Hor D, Dimaio T. Human tumors by NMR. Physiol Chem Phys. 1973;5(5):381–402.PubMed Damadian R, Zaner K, Hor D, Dimaio T. Human tumors by NMR. Physiol Chem Phys. 1973;5(5):381–402.PubMed
7.
Zurück zum Zitat • Grob ATM, Olde Heuvel J, Futterer JJ, Massop D. Veenstra van Nieuwenhoven AL, Simonis FFJ et al. Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings. Int Urogynecol J. 2019;30(11):1939–44. https://doi.org/10.1007/s00192-018-03862-0The authors reveal that POP is often staged incorrectly and quantitatively supports the importance of staging POP under the influence of gravity.CrossRefPubMedPubMedCentral • Grob ATM, Olde Heuvel J, Futterer JJ, Massop D. Veenstra van Nieuwenhoven AL, Simonis FFJ et al. Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings. Int Urogynecol J. 2019;30(11):1939–44. https://​doi.​org/​10.​1007/​s00192-018-03862-0The authors reveal that POP is often staged incorrectly and quantitatively supports the importance of staging POP under the influence of gravity.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Zacharakis D, Grigoriadis T, Bourgioti C, Pitsouni E, Protopapas A, Moulopoulos LA, et al. Pre- and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients? Neurourol Urodyn. 2018;37(1):316–21. https://doi.org/10.1002/nau.23294.CrossRefPubMed Zacharakis D, Grigoriadis T, Bourgioti C, Pitsouni E, Protopapas A, Moulopoulos LA, et al. Pre- and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients? Neurourol Urodyn. 2018;37(1):316–21. https://​doi.​org/​10.​1002/​nau.​23294.CrossRefPubMed
14.
Zurück zum Zitat • Juliato CRT, Santos-Junior LC, de Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation-a randomized trial. Neurourol Urodyn. 2019;38(4):1142–51. https://doi.org/10.1002/nau.23970The authors directly compared the two most cost common surgical interventions to treat vaginal wall prolapse and found no significant differences in the post-operative vaginal axis between the two approaches.CrossRefPubMed • Juliato CRT, Santos-Junior LC, de Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation-a randomized trial. Neurourol Urodyn. 2019;38(4):1142–51. https://​doi.​org/​10.​1002/​nau.​23970The authors directly compared the two most cost common surgical interventions to treat vaginal wall prolapse and found no significant differences in the post-operative vaginal axis between the two approaches.CrossRefPubMed
18.
Zurück zum Zitat Tasali N, Cubuk R, Sinanoglu O, Sahin K, Saydam B. MRI in stress urinary incontinence: endovaginal MRI with an intracavitary coil and dynamic pelvic MRI. Urol J. 2012;9(1):397–404.PubMed Tasali N, Cubuk R, Sinanoglu O, Sahin K, Saydam B. MRI in stress urinary incontinence: endovaginal MRI with an intracavitary coil and dynamic pelvic MRI. Urol J. 2012;9(1):397–404.PubMed
24.
Zurück zum Zitat Collado Serra A, Pelechano Gomez P, Martin I, Dominguez-Escrig J, Alberich-Bayarri A, Barrios M, et al. Magnetic resonance imaging as an assessment tool following intervention with an AdVance XP suburethral sling for postprostatectomy urinary incontinence. Neurourol Urodyn. 2019;38(6):1616–24. https://doi.org/10.1002/nau.24023.CrossRefPubMed Collado Serra A, Pelechano Gomez P, Martin I, Dominguez-Escrig J, Alberich-Bayarri A, Barrios M, et al. Magnetic resonance imaging as an assessment tool following intervention with an AdVance XP suburethral sling for postprostatectomy urinary incontinence. Neurourol Urodyn. 2019;38(6):1616–24. https://​doi.​org/​10.​1002/​nau.​24023.CrossRefPubMed
25.
29.
Zurück zum Zitat • Kadono Y, Nohara T, Kawaguchi S, Naito R, Urata S, Nakashima K, et al. Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence. BJU Int. 2018;122(3):456–62. https://doi.org/10.1111/bju.14181The authors’ findings provide a potential intra-operative metric (longer residual membranous urethral length) to aim for in order to provide patients with the best chance for achieving post-prostatectomy continence.CrossRefPubMed • Kadono Y, Nohara T, Kawaguchi S, Naito R, Urata S, Nakashima K, et al. Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence. BJU Int. 2018;122(3):456–62. https://​doi.​org/​10.​1111/​bju.​14181The authors’ findings provide a potential intra-operative metric (longer residual membranous urethral length) to aim for in order to provide patients with the best chance for achieving post-prostatectomy continence.CrossRefPubMed
31.
Zurück zum Zitat Onoda M, Haga N, Kurimura Y, Tanji R, Onagi A, Honda R, et al. Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot-assisted radical prostatectomy: a prospective observational study. Neurourol Urodyn. 2019;38(8):2200–8. https://doi.org/10.1002/nau.24117.CrossRefPubMed Onoda M, Haga N, Kurimura Y, Tanji R, Onagi A, Honda R, et al. Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot-assisted radical prostatectomy: a prospective observational study. Neurourol Urodyn. 2019;38(8):2200–8. https://​doi.​org/​10.​1002/​nau.​24117.CrossRefPubMed
32.
Zurück zum Zitat • Salem R, Hairston J, Hohlastos E, Riaz A, Kallini J, Gabr A, et al. Prostate artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia: results from a prospective FDA-approved investigational device exemption study. Urology. 2018;120:205–10. https://doi.org/10.1016/j.urology.2018.07.012The first FDA-approved open-label trial of PAE for BPH-related LUTS in 45 patients with prostate MRI being used to establish clear inclusion and exclusion criteria, as well as for obtaining baseline and 6-month follow-up.CrossRefPubMed • Salem R, Hairston J, Hohlastos E, Riaz A, Kallini J, Gabr A, et al. Prostate artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia: results from a prospective FDA-approved investigational device exemption study. Urology. 2018;120:205–10. https://​doi.​org/​10.​1016/​j.​urology.​2018.​07.​012The first FDA-approved open-label trial of PAE for BPH-related LUTS in 45 patients with prostate MRI being used to establish clear inclusion and exclusion criteria, as well as for obtaining baseline and 6-month follow-up.CrossRefPubMed
33.
45.
Zurück zum Zitat • Khavari R, Chen J, Boone T, Karmonik C. Brain activation patterns of female multiple sclerosis patients with voiding dysfunction. Neurourol Urodyn. 2020;39(3):969–77. https://doi.org/10.1002/nau.24304The first study to investigate the differences and similarities of brain regions involved in initiation of voiding in MS patients, and offer evidence to support the hypothesis that the higher neural activation during voiding would be different in MS patients with voiding dysfunction than those without voiding dysfunction.CrossRefPubMedPubMedCentral • Khavari R, Chen J, Boone T, Karmonik C. Brain activation patterns of female multiple sclerosis patients with voiding dysfunction. Neurourol Urodyn. 2020;39(3):969–77. https://​doi.​org/​10.​1002/​nau.​24304The first study to investigate the differences and similarities of brain regions involved in initiation of voiding in MS patients, and offer evidence to support the hypothesis that the higher neural activation during voiding would be different in MS patients with voiding dysfunction than those without voiding dysfunction.CrossRefPubMedPubMedCentral
59.
Zurück zum Zitat Nardos R, Karstens L, Carpenter S, Aykes K, Krisky C, Stevens C, et al. Abnormal functional connectivity in women with urgency urinary incontinence: can we predict disease presence and severity in individual women using Rs-fcMRI. Neurourol Urodyn. 2016;35(5):564–73. https://doi.org/10.1002/nau.22767.CrossRefPubMed Nardos R, Karstens L, Carpenter S, Aykes K, Krisky C, Stevens C, et al. Abnormal functional connectivity in women with urgency urinary incontinence: can we predict disease presence and severity in individual women using Rs-fcMRI. Neurourol Urodyn. 2016;35(5):564–73. https://​doi.​org/​10.​1002/​nau.​22767.CrossRefPubMed
63.
79.
82.
98.
Zurück zum Zitat • Pewowaruk R, Rutkowski D, Hernando D, Kumapayi BB, Bushman W, Roldan-Alzate A. A pilot study of bladder voiding with real-time MRI and computational fluid dynamics. PLoS One. 2020;15(11):e0238404. https://doi.org/10.1371/journal.pone.0238404This study demonstrates the potential for highly individualized therapies for benign urologic pathologies through the insights provided by novel, MRI-driven diagnostic modalities.CrossRefPubMedPubMedCentral • Pewowaruk R, Rutkowski D, Hernando D, Kumapayi BB, Bushman W, Roldan-Alzate A. A pilot study of bladder voiding with real-time MRI and computational fluid dynamics. PLoS One. 2020;15(11):e0238404. https://​doi.​org/​10.​1371/​journal.​pone.​0238404This study demonstrates the potential for highly individualized therapies for benign urologic pathologies through the insights provided by novel, MRI-driven diagnostic modalities.CrossRefPubMedPubMedCentral
99.
Zurück zum Zitat Peng Y, Khavari R, Nakib NA, Stewart JN, Boone TB, Zhang Y. The single-incision sling to treat female stress urinary incontinence: a dynamic computational study of outcomes and risk factors. J Biomech Eng. 2015;137(9). https://doi.org/10.1115/1.4030978. Peng Y, Khavari R, Nakib NA, Stewart JN, Boone TB, Zhang Y. The single-incision sling to treat female stress urinary incontinence: a dynamic computational study of outcomes and risk factors. J Biomech Eng. 2015;137(9). https://​doi.​org/​10.​1115/​1.​4030978.
Metadaten
Titel
Contemporary Review of MRI in Benign Genitourinary Pelvic Medicine: What Every Urologist Should Know
verfasst von
Darshil Choksi
Bradley Schott
Khue Tran
Rose Khavari
Publikationsdatum
31.05.2021
Verlag
Springer US
Erschienen in
Current Bladder Dysfunction Reports / Ausgabe 3/2021
Print ISSN: 1931-7212
Elektronische ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-021-00631-6

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