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Objective: This study compared dynamic MR imaging with fluoroscopic cystocolpoproctography for the detection and measurement of prolapse of pelvic organs., Subjects and Methods: Ten patients underwent triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography with identical amounts of contrast material to opacify the bladder, vagina, and rectum. The dynamic MR imaging procedure included cine-loop presentation. Each examination was analyzed to determine the presence and extent of prolapse of pelvic organs based on specific measurements., Results: Both dynamic MR imaging and fluoroscopic cystocolpoproctography revealed 10 rectoceles (mean extents, 2.85 and 2.45 cm, respectively). Nine cystoceles were revealed by both dynamic MR imaging (mean extent, 4.05 cm) and fluoroscopy (mean extent, 4.55 cm). Seven enteroceles were revealed, one of which was initially not seen on dynamic MR imaging. Two sigmoidoceles were revealed, one of which was not seen on fluoroscopy. The mean extent of the enteroceles and sigmoidoceles on dynamic MR imaging was 3.50 cm, and the mean extent on fluoroscopy was 4.25 cm. Nine of the 10 patients were able to defecate in the supine position on the MR imaging table. Patients were divided equally in their preference for dynamic MR imaging or fluoroscopic cystocolpoproctography., Conclusion: Triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctograpy show similar detection rates for prolapse of pelvic organs. Although dynamic MR imaging underestimates the extent of cystoceles and enteroceles, it has the advantage of revealing all pelvic organs and the pelvic floor musculature in a multiplanar cine-loop presentation.

Objective: The aim of this study was to assess the contribution of dynamic cystoproctography to the evaluation of female pelvic organ prolapse and to compare this contribution with that of physical examination., Materials and Methods: The presence or absence of rectocele, enterocele, sigmoidocele, and cystocele on physical examination and on cystoproctography was retrospectively analyzed in 170 consecutive patients. For each of these diagnostic methods, organ prolapse was graded as small, moderate, or large on the basis of specific, defined measurements., Results: A rectocele was detected by proctography in 155 patients (91%); 119 (77%) of these rectoceles were also found on physical examination. Barium trapping at proctography was related to rectocele size. Proctography showed an enterocele in 47 patients (28%); 24 (51%) of these enteroceles were also found on physical examination. Physical examination also found 44 enteroceles that could not be corroborated radiologically. At proctography, the enteroceles were relatively large, extending an average of 7.3 cm below the vaginal apex. Eight patients had sigmoidoceles, none of which were found on physical examination. A cystocele was shown by cystoproctography in 159 patients (94%); 132 (83%) of these cystoceles were also found on physical examination., Conclusion: The correlation between finding prolapsed pelvic organs on dynamic cystoproctography and finding them on physical examination varies. Most radiographically detected rectoceles and cystoceles are found on physical examination, whereas the correlation for enteroceles and sigmoidoceles is poor. Dynamic cystoproctography provides direct visualization and quantification of female pelvic organ prolapse, information that usually can only be inferred by physical examination.

Objective: Dynamic cystoproctography was used to determine the frequency of associated urinary, genital, and anorectal abnormalities in women with pelvic floor dysfunction., Subjects and Methods: We categorized, by pelvic floor compartments, the symptoms at presentation of 100 consecutive female patients who had been referred for dynamic cystoproctography. We then analyzed the compartment defects seen on dynamic cystoproctography relative to those detected on clinical presentation., Results: Of the 20 patients with symptoms of anterior compartment (urinary) defect, dynamic cystoproctography revealed that 45% had vaginal vault prolapse of more than 50% and that 90% had rectoceles. Of the 45 patients with symptoms of middle compartment (genital) defect, dynamic cystoproctography revealed that 91% had cystoceles, 56% had a hypermobile bladder neck, 82% had rectoceles, 58% had enteroceles, 11% had sigmoidoceles, 20% had rectoanal intussusception, and 16% had anal incontinence. Of the 17 patients with symptoms of posterior compartment (anorectal) defect, dynamic cystoproctography showed that 71% had cystoceles, 65% had a hypermobile bladder neck, and 35% had vaginal vault prolapse of more than 50%. Of the 18 patients with symptoms of defects from a combination of compartments, dynamic cystoproctography revealed that 89% had cystoceles, 56% had a hypermobile bladder neck, 39% had vaginal vault prolapse exceeding 50%, 100% had rectoceles (of which 45% were large), 6% had enteroceles, 6% had sigmoidoceles, 22% had rectoanal intussusception, and 6% had anal incontinence., Conclusion: Although patients may present with symptoms that involve only one compartment, a multicompartment prolapse is usually revealed on dynamic cystoproctography. Of the patients with pelvic floor dysfunction, 95% had abnormalities in all three compartments.