MRI detection of early post-operative haematomas

A NEW study has shown, for the first time,the role of MRI in the detection of early postoperative retropubic haematoma after minimally-invasive sling procedures in the treatment of female stress urinary incontinence (SUI). Spearheaded by IJMS Doctor Awards Urologist Finalist Dr Subhasis Giri,the research has exciting implications for clinical practice. He explained to Medicine Weekly that MRI has now proved itself as a very useful non-invasive modality for the detection of early postoperative retropubic haematomas, of which the study revealed a surprisingly high incidence, especially after the xenograft sling procedure. He added that large haematomas may have previously unrecognized effects on postoperative bladder-emptying and these new data may also serve as reference values for future studies of the retropubic haematoma after anti-incontinence procedures. “MRI is the imaging modality of the future and is going to replace other, more hazardous, imaging techniques in urology,”said the Registrar in Urology at Mid-Western Regional Hospital, Limerick.“The results of our MRI study give valuable insight into the retropubic haematoma after different types of sling surgery.” Using MRI, the research examined the incidence of retropubic haematoma and any associated clinically significant effects following xenograft (porcine dermis) sling (XS) or the tension-free vaginal tape (TVT) procedure. Overall, a quarter of patients (six in total: four in the XS and two in the TVT) developed a retropubic haematoma. Haematomas appeared as low to medium signal intensity areas in T1-W sequence and as medium to high intensity areas in T2W sequence. Most commonly, they spread along the right paravesicourethral space between the right half of the levator ani and the bladder neck. Two patients following XS developed a large haematoma. These patients took significantly longer to void (median 14.5 v 6.0 hr, p = 0.048). The median postoperative bladder emptying efficiency (EE) of the first void was lower in patients with haematoma — 40 per cent versus 58.5 per cent for those without haematoma. However, the study found there was no difference in pain score in patients with or without haematoma. None of the patients had clinically-detectable haematomas in the suprapubic wound and all six patients with haematomas were cured or improved at six months follow-up. While working in the urology unit at Mid-Western Regional Hospital, Dr Giri took the opportunity to design and conduct this research project under the supervision of Mr Hugh Flood, consultant urologist. This unit has considerable prior clinical research experience in sling surgery for stress urinary incontinence. “The future of anti-incontinence surgical therapy is bright and promising. With advances in biomechanical engineering coupled with clinical and basic science research, our understanding of the incontinence disease process and the development of new surgical options are increasing rapidly,”said Dr Giri, who graduated from Calcutta University in India in 1995. Hailing from a small village near Calcutta, he travelled to Ireland for further training in urology after obtaining an MS degree from the University College of Medicine, Calcutta, and has since attained Fellowships in Surgery from the Royal College of Surgeons in Ireland and Edinburgh. “My research work in Urology has deepened my understanding of various urological problems,”he said. “Ultimately, my goal is to continue to contribute to the overall body of knowledge in urology and improve the quality of patient care.”