3D reconstruction of MR‐visible Fe₃O₄‐mesh implants: Pelvic mesh measurement techniques and preliminary findings

Abstract

Aims: To develop MR-based measurement technique to evaluate the postoperative dimension and location of implanted magnetic resonance (MR)-visible meshes. Methods: This technique development study reports findings of six patients (A-F) with cystoceles treated with anterior vaginal MR-visible Fe3O4-polypropylene implants. Implanted meshes were reconstructed from three months and/or one year postsurgical MR-images using 3D Slicer®. Measurements including mesh length, distance to the ischial spines, pudendal and obturator neurovascular bundles and urethra were obtained using software Rhino® and a custom Matlab® program. The range of implanted mesh length and their placements were reported and compared with mesh design and implantation recommendations. With the anterior/posterior-mesh-segment-ratio mesh shrinkage localization was evaluated. Results: Examinations were possible for patients A-D three months and for A, C, E and F one year postsurgical. The mesh was at least 40% shorter in all patients three months and/or one year postoperatively. A, B showed shrinkage in the anterior segment, D, E in the posterior segment (Patients C, F not applicable due to intraoperative mesh trimming). Patient E presented pain in the area of mesh shrinkage. In Patient C posterior mesh fixation was placed in the iliococcygeal muscle rather than sacrospinous ligaments. Arm placement less than 20 mm from the pudendal neurovascular bundles was seen in all cases. The portion of the urethra having mesh underneath it ranged from 19% to 55%. Conclusions: MRI-based measurement techniques have been developed to quantify implanted mesh location and dimension. Mesh placement variations possibly correlating with postoperative complications can be illustrated.

An Unusual Case of Acute Complete Urinary Incontinence 20 Days after Pelvic Floor Surgery and Tension-Free Vaginal Tape Insertion 20 Days after Pelvic Floor Surgery and Tension-Free Vaginal Tape Insertion

“…Sonography allows dynamic imaging and the sling implants are highly echogenic [9]. In MR scan they are not clearly visible, except for MR-visible Fe 3 O 4 -mesh implants [10]. Four months later the hematoma had partially resorbed but the urinary incontinence was basically unchanged.…”