Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI?

Introduction and hypothesis: This study seeks to quantify differences in anterior vaginal wall prolapse during sequential Valsalva attempts on dynamic magnetic resonance imaging (MRI). Methods: Subjects were taken from an on-going case-control study evaluating anterior vaginal wall prolapse. Women with a prolapse whose leading edge extended ≥1 cm beyond the hymenal ring were included (n=40). All subjects performed three maximal Valsalva efforts while mid-sagittal dynamic MRI scans were obtained. Bladder descent between the first, second, and third maximal Valsalva efforts were compared. Results: Forty percent of women had a greater than 2-cm increase in prolapse size from their first to third Valsalva attempt. Ninety-five percent of women extended their prolapse further with a third Valsalva. Conclusions: As is true during clinical examination, several attempts may be required to have maximal anterior compartment prolapse present during dynamic MRI of the pelvic floor.