Magnetic resonance imaging of defects in DeLancey's vaginal support levels I, II, and III.

Abstract

The aim was to demonstrate paravaginal defects at DeLancey's levels I, II, and III by pelvic magnetic resonance imaging scanning in patients with symptomatic pelvic relaxation preoperatively and to demonstrate the disappearance of such defects after surgical repair. Magnetic resonance imaging scans of the pelvis were performed in 12 patients exhibiting cystourethroceles and symptomatic urinary stress incontinence. Magnetic resonance imaging scans of bilateral fascial defects at the upper third of the vagina (level I) were unremarkable except for the constant "chevron sign," whereas the middle third of the vagina (level II) displayed the "saddlebags sign," and the lower third of the vagina (level III) displayed the "mustache sign." These defects disappeared postoperatively. Bilateral defects in the paracolpium at vaginal support levels I, II, and III may be found by magnetic resonance imaging scans before surgery in certain patients with symptomatic pelvic relaxation. Postoperative scans after paravaginal repair demonstrate the disappearance of these defects.