Background Stress urinary incontinence (SUI) is a common disabling pelvic floor dysfunction, particularly among aging women. Magnetic resonance imaging (MRI) with dynamic sequences has been proven reliable for detecting pelvic floor weaknesses, especially with multiple compartments defects. Since surgical and non-surgical management options exist, detailed imaging analysis and comprehension of the various surgical and non-surgical interventions are crucial for surgical planning and postoperative evaluation. However, patients often present with recurrent or new symptoms after surgery, where MR imaging is necessary to detect complications in this setting. We aimed to analyze MR images pre- and postoperative/intervention using the defect-specific approach aiming at better understanding of the underlying complication and/or the cause of recurrence. Results Thirty female patients with SUI were included in the study; 20 underwent surgery, 6 were treated by physiotherapy only, while 3 patients underwent both surgery and physiotherapy and 1 patient was treated conservatively. According to their clinical symptoms, patients with successful surgical/physiotherapy outcome were 18 cases (60%), while unsuccessful group comprised of 12 cases (40%) is classified as follows: persistent complaints subgroup 7 patients (23.3%), de novo complaint subgroup 2 patients (6.7%), while the complicated subgroup is comprised of 2 patients (6.7%) and the persistent/de novo complaints subgroup of the unsuccessful group is composed of 1 case (3.3%). They all underwent MRI of the pelvic floor with a standardized technique, pre- and postoperative/physiotherapy. Changes in level III endopelvic fascia defects between the pre- and postoperative/physiotherapy studies were statistically significant (p = 0.045). Urinary bladder and uterine descent were also found statistically significant between the pre- and postoperative/physiotherapy studies (p = 0.001 and p = 0.029, respectively). Comparing successful and unsuccessful groups pre- and postoperative/therapy, levator plate angle (LPA) was found statistically significant as well (p = 0.039 preoperative and p = 0.001 postoperative). Conclusions Analysis of the pre- and postoperative static and dynamic MRI sequences along with proper understanding of the preformed intervention can pinpoint the underlying pathology leading to the recurrent or de novo symptom and/or complications. The defect-specific approach can help determine the underlying pelvic floor defect by altering the MRI techniques tailored for each patient according to their complaint.

Objective: Radiological findings in solitary rectal ulcer syndrome (SRUS) are well described for evacuation proctography (EP) but sparse for magnetic resonance defecography (MRD). In order to rectify this, we describe the spectrum of MRD findings in patients with histologically proven SRUS.Materials and methods: MRD from twenty-eight patients (18 female; 10 males) with histologically confirmed SRUS were identified. MRD employed a 1.5T magnet and a standardized technique with the rectal lumen filled with gel and imaged sagittally in the supine position, before, during and after attempted rectal evacuation. A single radiologist observer with 5 years' experience in pelvic floor imaging made anatomical and functional measurements.Results: Sixteen patients (10 female) demonstrated internal rectal intussusception and 3 patients (11%) demonstrated complete external rectal prolapse. Anterior rectoceles were noted in 12 female patients (43%). Associated anterior and middle compartment weakness (evidenced by excessive descent) was observed in 16 patients (57%). Enterocoeles were detected in 5 patients (18%) and peritoneocoele in 5 patients (18%). None had sigmoidocoele. Sixteen patients (57%) demonstrated delayed voiding and 13 patients (46%) incomplete voiding, suggesting daefecatory dyssynergia. Conclusion:MRD can identify and grade both rectal intussusception and dyssynergia in SRUS, and also depict associated anterior and/or middle compartment descent. Distinction between structural and functional findings has important therapeutic implications.

Objective To evaluate the interobserver agreement for the features of natal cleft pilonidal sinus disease (PSD) on magnetic resonance imaging (MRI) and propose a standardized checklist for reporting PSD on MRI. Materials and methods Forty MRI studies of 39 discrete patients with PSD were retrospectively evaluated by five independent radiologists using a standardized checklist. Fleiss’ Kappa (k) coefficients of agreement were used to test the agreement between categorical variables. The MRI features of the natal cleft sepsis associated with PSD were classified into four main categories: morphology, branching and extensions, external skin openings, and the relationship of the PSD to the coccyx. A survey was created and disseminated online among general surgeons who treat patients with PSD to assess the relevance of the MRI features proposed in the standardized checklist. Results The overall agreement regarding the identification of morphology of the natal cleft sepsis was moderate (k = 0.59). Lateral and caudal extensions interobserver agreement was substantial (k = 0.64 and 0.71, respectively). However, the overall agreement regarding the individual parts of anal sphincter involved was moderate (k = 0.47). Substantial interobserver agreement was found in assessing the proximity of the PSD to the coccyx (k = 0.62). Conclusion Preoperative MRI can delineate the extensions and branching of PSD with substantial agreement. MRI is superior in describing the deep extensions of PSD with better reliability than assessing the number and locations of the external openings. Expert consensus agreement is needed to establish the MRI features necessary for optimal reporting of PSD. Clinical relevance statement MRI can offer valuable information about the extent of sepsis associated with pilonidal sinus disease, particularly in cases with involvement of critical anatomical structures such as the coccyx and anal triangle. MRI can potentially contribute to more accurate patient stratification and surgical planning. Key Points • The interobserver agreement for assessing PSD’s lateral and caudal extension on MRI is substantial. • MRI can describe deep extensions and branching of PSD with superior reliability than assessing the number and site of external openings. • Reporting the relationship between natal cleft sepsis in PSD and the anal region may influence the surgical approach and postoperative healing.