Does prenatal MRI enhance fetal diagnosis of intra-abdominal cysts?

OBJECTIVE: The aim of this study was to evaluate the contribution of prenatal magnetic resonance imaging (MRI) to ultrasound (US) in the prenatal diagnosis of intra-abdominal cystic masses, correlated with the postnatal diagnosis. METHODS: In this retrospective, observational study, prenatal MRI and US diagnoses were compared with postnatal diagnoses. MRI was performed in 56 fetuses with intra-abdominal cyst diagnosed by US between 2004 and 2013. Final diagnosis, revealed by postnatal evaluation, was obtained for 49 of them and was taken as the reference. MRI was evaluated as superior, equal, or inferior to US. RESULTS: An accurate diagnosis was provided by US in 25 cases (51%) and by MRI in 36 out of the 49 cases (73.4%). MRI corrected the US diagnosis in 13 cases (26.5%) by providing a more precise localization or additional etiologic information. In two cases (4%), MRI wrongly changed the diagnosis correctly made by US. CONCLUSION: Prenatal MRI better characterized the nature of abdominal cystic lesions previously diagnosed by US in 13 cases. This enhanced postnatal therapeutic planning and so improved parental counseling and pregnancy management.

Two years follow up of 270 patients treated by transvaginal mesh for anterior and/or apical prolapse.

OBJECTIVE: The aim of this study was to assess the 1 and 2 years outcomes of transvaginal single incision mesh surgery (SIMS) for anterior pelvic organ prolapse (POP). MATERIAL AND METHODS: This was a prospective study including all patients from November 2008 to December 2012 who underwent SIMS for symptomatic anterior prolapse stage≥2, according to the POP Quantification (POP-Q). Symptoms and quality of life were assessed using validated questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact questionnaire (PFIQ-7), and Prolapse/Incontinence Sexual Questionnaire (PISQ-12). The main outcome was subjective success (question 3 of PFDI-20 score=0). Safety, anatomic and functional outcomes were used as the secondary outcomes. RESULTS: A total of 270 patients were included in the study. Subjective success rate was 95,4% and 92,2% at 1 and 2 years. Objective success rate was 65,9%and 60,5% at 1 and 2 years. At 1year, composite failure (subjective+objective) occurred for 11 patients (4,6%), 5 patients with direct recurrence and 6 with indirect recurrence. At 2 years, composite failure was reported for 14 patients (6,4%): 6 direct recurrences and 8 indirect recurrences. Re-treatment was performed in one case (0,4%). One case (0,4%) of asymptomatic mesh exposure occurred. The reoperation rate for mesh-related complications was 3%. We reported a de novo dyspareunia rate of 8,4%, 5,3% considered as mesh-related. A significant improvement was noted for symptoms and quality of life. CONCLUSION: POP repair using SIMS is a safe and efficient treatment of anterior compartment prolapse in the medium term with a low rate of mesh-related complications. Longer-term follow-up is ongoing.