SCOTTSDALE, AZ USA (UroToday.com) - Dr. Alan Wein moderated a panel of clinicians in a pro/con debate over the utility of radiological evaluation of SUI and POP.
Dr. Christian Twiss presented “Vital to optimal diagnosis and management,” He noted that there are no level 1 data and no society guidelines to support either argument. While dynamic pelvic MRI has been shown to have good inter/intraobserver reliability, the findings have been shown to have a poor correlation with low-stage pelvic organ prolapse. The largest gap was seen with rectoceles. He did not feel this was a clinical issue as it is uncommon to pursue radiologic evaluation of low-stage pelvic organ prolapse. Dr. Twiss feels that MRI is most beneficial in detecting enteroceles that are often missed on clinical exam. Two studies were reviewed which showed that dynamic MRI altered treatment management in 20-41% of cases and improved surgeons’ confidence in their diagnosis and plan. Transperineal sonogram is very operator dependent, no better than clinical exam, and has not been shown to alter care management for prolapse. However, ultrasound has been shown to be beneficial in assessing for levator avulsion, residual mesh, and mesh-related symptoms.
Dr. Howard Goldman presented ”Unnecessary and costly.” He does not feel that the cost of imaging is justified by its limited to no proven benefit. While MRI may show a change in pelvic anatomy angles and descent on Valsalva maneuvers, the relationship of these MRI findings to the exam, patient symptoms, and treatment management are speculative at best. He stressed that in multiple papers that Dr. Twiss referenced to support the use of imaging, the authors in their own conclusion of their manuscripts stated that their data was “inconclusive” and “speculative.”
Moderated by Alan J. Wein, MD, FACS, PhD (Hon) at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
Panelists:
Vital to optimal diagnosis and management: Christian O. Twiss, MD
Unnecessary and costly: Howard B. Goldman, MD, FACS
Reported for UroToday by Drew Freilich, MD. Dr. Freilich is a graduate of the University of Massachusetts Medical School and completed his urology residency at New York Medical College/Westchester Medical Center. He is currently a fellow in Female Urology, Neurourology and Reconstructive Urology at Medical University of South Carolina. He has authored more than 40 peer-reviewed articles, monographs, abstracts, and book chapters and abstracts. Dr. Freilich is a member of the American Urological Association and the Society for Urodynamics and Female Urology.