European Journal of Radiology 44 (2002) 44 – 47 Magnetic resonance imaging for stress incontinence: evaluation of patients before and after surgical correction Hakkı Perk a, *, Baha Oral b , Ahmet Yes ¸ildag ˘ c , T. Ahmet Serel a , Mesut O  zsoy b , Tayfun Turgut c a Urology Department, School of Medicine, Su ¨leyman Demirel Uniersity, Isparta, Turkey b Gynecology and Obstetrics Department, School of Medicine, Su ¨leyman Demirel Uniersity, Isparta, Turkey c Radiology Department, School of Medicine, Su ¨leyman Demirel Uniersity, Isparta, Turkey Received 18 October 2001; received in revised form 12 November 2001; accepted 15 November 2001 Abstract Objectie: The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in the pre and postoperative assessment of stress urinary incontinence. Methods: Fifteen female patients with clinical evidence of stress urinary incontinence were included in this prospective study. All the patients underwent MRI in the supine position both preoperatively and postoperatively. For imaging, we used a 1.0 T magnet, T2-weighted images were obtained in the midline sagittal plane with patients at rest. Images were evaluated for anatomical stress urinary incontinence alterations, such as the increased distance between the pubococcygeal line and the bladder base and the posterior urethro – vesical angle and the urethral inclination angle changes. Wilcoxon signed rank test allowed comparisons of pre and postoperative results. Results: Compared with postoperative measurements, the bladder base was lowered significantly by an average of 9.4 4.0 mm (P 0.01), posterior urethro – vesical angle was significantly increased by an average of 127.8 11.4° (P 0.01), and the urethral inclination angle was significantly increased by an average of 54.9 10.1° (P 0.01) preoperatively. Conclusion: Our results suggest that MRI can play a major role in the preoperative and postoperative assessment of stress urinary incontinence. It can reliably detect anatomical urinary incontinence alterations. MRI should be considered in failed surgery, complex prolapse, and in differentiating genuine stress incontinence resulting from malposition of the bladder neck from stress incontinence due to intrinsic urethral damage. © 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Urinary incontinence; Magnetic resonance imaging; Pelvic floor; Pelvic organs www.elsevier.com/locate/ejrad 1. Introduction Urinary incontinence can be a symptom of which patients complain, a sign demonstrated on examination, or a condition (i.e. diagnosis) that can be confirmed by definitive studies [1]. It is a common disorder in women [2]. The history and physical examination are the first and most important steps in the evaluation. If complex conditions are present, if the patient does not improve after initial therapy, or if surgery is being considered, definitive, specialized studies are necessary [1]. The causes of incontinence are numerous, as are the methods to evaluate the degree of this disease [3–7]. Morphologic evaluation of pelvic floor descent and urinary incontinence is traditionally performed by bead-chain cystourethrography, colpo cystorectogra- phy, video-cystourethrography and ultrasonography. Magnetic resonance imaging (MRI) is rapidly be- coming an important diagnostic tool in the assessment of pelvic pathology. It is noninvasive and does not require ionizing radiation [1]. Dynamic MRI of the pelvic floor was first reported by Yang et al. [8] in 1991 using the T1-weighted gradient recalled acquisition in a steady-state pulse (GRASS) sequence with acquisition times between 6 and 12 s. The development of fast * Correspondng author. Present address: Kurtulus ¸ Mah. 1420 Sokak, 22/3, Isparta, Turkey. Tel.: +90-246-237-1747; fax: +90- 246-237-1762. E-mail address: hakkiperk@yahoo.com (H. Perk). 0720-048X/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0720-048X(01)00472-7