Dynamic rest sequences identified the following abnormalities: 23 cases of single compartment pathology: 2 mild cystoceles and 21 posterior compartment descent (PCD) -19 mild 2 and moderate -
Dynamic evacuation sequences revealed 23 mild, 4 moderate and 1 severe cystoceles (n. 28); 9 mild and 4 moderate middle compartment prolapse (n. 13); 6 mild, 16 moderate and 16 severe PCD (n. 38). 32/38 showed anterior rectocele and 6/38 didn’t show remarkable rectocele.
PCDs showed the following variations between rest and evacuation phase: 20 cases with no PCD at rest became 8 severe, 7 moderate and 3 mild PCD subsequently; 2 cases of moderate PCD became 2 severe PCD. Then 19 cases of initial mild PCD became 6 severe, moderate and 3 mild PCD.
Among defecation sequences, we observed 7 single compartment prolapses, 18 two compartments prolapses (16 anterior+posterior and 2 middle+posterior) and 12 prolapses of all the three compartments.
We also reported 4 peritoneoceles (all associated with severe PCD) and 2 cases of vaginal vault prolapse (associated with mild middle compartment prolapse).
Static sequences identified 16 patients out of 42 with abnormal levator ani muscle signal or morphology: 16 cases of levator ani increased width, 5 cases of iliococcygeus asymmetry and 10 cases of pubococcygeus loss of upward convexity.
13 out 16 levator ani abnormalities were related to severe PCD, while 5 to moderate PCP and 2 to no remarkable PCD.
We also reported 8 cases of horizontal angulation of the urethra. 7/8 associated with mild cystocele and 1/8 to moderate cystocele.
Additional gynaecological findings included 2 patients with Nabothian cysts, 1 pelvic varicocele, 1 IUD, 1 outcome of hysterectomy and 1 case of free-fluid in Douglas pouch.
Pathology
Anterior:
Cystocele is diagnosed when the bladder base descends more than 1 cm below the PCL and can manifest with stress incontinence.
In cases in which there is loss of urethral sphincter and fascial support, an increase of abdominal pressure allows rotation of the urethral axis into the horizontal plane. This condition is called urethral hypermobility.
Middle:
Middle compartment abnormalities are represented by uterine or vaginal vault prolapse.
Vaginal or cervical prolapse is defined as descent of the vaginal vault or cervix below the PCL. In complete uterine prolapse, the vaginal walls are everted and the uterus is visible as a bulging mass outside the external genitalia.
Posterior:
Rectoceles are measured as the depth of wall protrusion beyond the expected margin of the normal anorectal wall, and they are clinically significant when the bulge exceeds 2 cm during evacuation.
Enterocele is the prolapse of bowel loops and mesenteric fat in the recto-uterine pouch. The only presence of mesenteric fat is better described as Peritoneocele. [5]