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PELVIC FLOOR LAXITY<br />   PATIENT COMPLAINTS <br />Menstrual                                                            ...
Quantitative Assesement<br />Pubococcygeal line.                                                                          ...
RADIOLOGICAL RESPONSIBILITY<br />Define  and look for ?<br />Dynamic MR  to be done<br />Cystocele<br />Uterine / vaginal ...
What to report ?<br />Myofascial compartments<br />Endopelvic fascia<br />Levatorani<br />Iliococcygeal<br />Puborectal mu...
CASE-70 yr femlae<br />Clinical brief <br />Post  menopausal <br />cystocele/ rectocele/ third degree cervical descent .  ...
Quantitative assesment<br />
HYSTEROTOSIS<br />PUBO COCCYGEAL LINE<br />H LINE <br />M LINE<br />
HYSTEROTOSIS<br />Uterus  descent into the labia and outside. Small bowel descent >2cm into the bldeer/ rectum space. Shar...
HYSTEROTOSIS<br />PUBO COCCYGEAL LINE.<br />H LINE<br /> M LINE<br />
PUBO-COCCYGEAL SLING<br />PROLAPSE CONTENTS IN THE LABIA<br />
PROLAPSED CONTENTS IN THE LABIA<br />
EDEMA IN THE PROPALSE CONTENTS IS S/O INFECTION ON FAT SAT  <br />
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Hysterotosis

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Hysterotosis

  1. 1. PELVIC FLOOR LAXITY<br /> PATIENT COMPLAINTS <br />Menstrual <br />Stress incontinence <br />Uterine prolapse<br />Constipation <br />Incomplete defacation<br />MERCURY IMAGING INSTITUTE SEC 9C<br />SCO172-173<br />MERCURY IMAGING CENTRE SEC 20D<br />SC0 16-17<br />RISK FACTORS<br />Multiparous<br />Menopausal<br />Obesity<br />
  2. 2. Quantitative Assesement<br />Pubococcygeal line. <br />H LINE <br />M LINE <br />Angle of the levator plate with pubococcygeal line<br />Descent of the small bowel 2cm between the rectum and urinary bladder<br />Degree of descent : (In relation to puboccoccygeal line)<br />Organ descent > 1cm ( pelvic floor laxity).<br />Organ descent > 2cm ( surgical repair indicated).<br />
  3. 3. RADIOLOGICAL RESPONSIBILITY<br />Define and look for ?<br />Dynamic MR to be done<br />Cystocele<br />Uterine / vaginal vault prolapse<br />Enterocele<br />Rectocele<br />Anterior buldge of the rectum<br />Thinning / tears of the puborectaliliococcygeal muscles.<br />Bladder neck / vaginal orifice / anorectal junction All three should be above or at the pubo-coccygeal line.<br />MR – Investigation of benefit if multicompartment pelvic floor laxity is there as the surgery then is usually complex <br />Sagitttal plane is important (Normal supine). (post valsalvaemaneuvour)<br />
  4. 4. What to report ?<br />Myofascial compartments<br />Endopelvic fascia<br />Levatorani<br />Iliococcygeal<br />Puborectal muscle<br />Axial image<br /> Entirety of levator sling with similar thickness / homogenous low signal intensity. Appreciate pubovesicleligamants.<br />Coronal image<br />Iliococcygeal sling upward convex.<br /> Vagina : normal symmetrical orifice Normal H shape configuration in the coronal scans.<br />Urethera : slight anterior orientation of the bladder neck.<br />Define the Compartment :<br />Anterior ( Urethera/ bladder neck)<br />Middle ( vagina )<br />Posterior ( rectum ).<br />
  5. 5. CASE-70 yr femlae<br />Clinical brief <br />Post menopausal <br />cystocele/ rectocele/ third degree cervical descent . <br />Cervical biopsy : microinvasivesquamous cell carcinoma of cervix with high grade squamous intraepithelial lesion.<br />
  6. 6. Quantitative assesment<br />
  7. 7. HYSTEROTOSIS<br />PUBO COCCYGEAL LINE<br />H LINE <br />M LINE<br />
  8. 8. HYSTEROTOSIS<br />Uterus descent into the labia and outside. Small bowel descent >2cm into the bldeer/ rectum space. Sharp angulation of urethera with bladder neck is lost <br />
  9. 9. HYSTEROTOSIS<br />PUBO COCCYGEAL LINE.<br />H LINE<br /> M LINE<br />
  10. 10. PUBO-COCCYGEAL SLING<br />PROLAPSE CONTENTS IN THE LABIA<br />
  11. 11. PROLAPSED CONTENTS IN THE LABIA<br />
  12. 12. EDEMA IN THE PROPALSE CONTENTS IS S/O INFECTION ON FAT SAT <br />

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