Role of MRI in Diagnosing De Novo Stress Urinary Incontinence in Female Athletes with Severe Pelvic Organ Prolapse Before Pelvic Floor Rehabilitation

Abstract

Introduction and Hypothesis: This study evaluates the utility of magnetic resonance imaging (MRI) in identifying risk factors for de novo stress urinary incontinence (SUI) in female athletes with pelvic organ prolapse (POP) before undergoing pelvic floor rehabilitation.

Methods: In a prospective analysis, female athletes scheduled for POP surgery from 2019 to 2020, who had not previously reported SUI, underwent preoperative pelvic floor MRI. The imaging focused on assessing levator ani muscle (LAM) injury, urethral sphincter dysfunction, vesical neck downward movement, and urethral length and mobility. Based on the 3-month to 1-year postoperative follow-up, patients were categorized into the de novo SUI group or the continent group. The prevalence of pelvic floor abnormalities was compared between the groups.

Results: Of the 47 patients, 5 developed de novo SUI postoperatively. Those in the de novo SUI group exhibited significantly more LAM injuries. All patients with de novo SUI demonstrated urethral sphincter dysfunction and funneling, in contrast to only 7.14% in the continent group. Vesical neck downward movement was more pronounced in the de novo SUI group (t = –0.655, P = 0.016). However, urethral mobility did not differ significantly between the groups (t = 0.123, P = 0.903).

Conclusion: In female athletes with POP, preoperative MRI findings of urethral sphincter dysfunction, funneling, significant LAM injuries, and pronounced vesical neck downward movement serve as predictive indicators of de novo SUI. These insights are crucial for tailoring preoperative counseling and optimizing pelvic floor rehabilitation strategies to mitigate the risk of SUI post-surgery.