International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 34-43 http://medscipublisher.com/index.php/ijccr 38 Prolapse repairs, which may involve reconstructive surgery to restore the normal position of pelvic organs, are another option for severe PFD cases. These surgeries can significantly improve symptoms and quality of life, but they also carry risks of complications and require careful patient selection and counseling. The decision to pursue surgical intervention should be based on a comprehensive evaluation of the patient's symptoms, overall health, and personal preferences, with a focus on minimizing risks and optimizing outcomes (Marcu et al., 2023). 6 Case Analysis 6.1 Case presentation The patient, a 78-year-old woman, had a history of gynecological malignancy and subsequent surgery, leading to urinary incontinence (Khatri et al., 2016). To alleviate her symptoms, the patient underwent periurethral collagen injection therapy. Post-treatment, Magnetic Resonance Imaging (MRI) was performed to evaluate the distribution and efficacy of the injected collagen. 6.2 Imaging findings Post-treatment MRI revealed several significant findings regarding the distribution and characteristics of the injected collagen. On the Axial T2-weighted Fast Spin-Echo Image (Figure 1a) (Khatri et al., 2016), circumferential high-signal-intensity material, representing the injected collagen, was clearly visible surrounding a centrally hypointense collapsed urethral lumen. This material appeared as a well-defined circular mass, evenly distributed around the urethra, indicating precise placement of the bulking agent. The Sagittal T2-weighted Fast Spin-Echo Image (Figure 1b) further highlighted the high-signal-intensity collagen symmetrically distributed along the anterior and posterior walls of the midportion of the urethra (Khatri et al., 2016). This symmetrical pattern demonstrated the structural support provided by the injected material, effectively reinforcing the urethral walls. The Axial 3D Contrast-enhanced T1-weighted Fat-suppressed Gradient-echo Image (Figure 1c) revealed a lack of enhancement in the collagen material (Khatri et al., 2016). This non-enhancing characteristic was crucial in differentiating the injected collagen from other pathological conditions, such as urethral diverticula or solid masses, which typically exhibit enhancement on contrast imaging. These findings underscore the utility of MRI in assessing the precise placement and functional outcomes of collagen injections. Figure 1 Collagen injection in a 78-year-old woman (Adopted from Khatri et al., 2016) Image caption: a) Axial T2-weighted fast SE MR image shows circumferential high-signal-intensity collagen (arrows) surrounding the hypointense collapsed lumen (arrowhead) centrally., b) Sagittal T2-weighted fast SE MR image shows high-signal-intensity collagen material (arrows) along the anterior and posterior wall of the midportion of the urethra (*)., c) Axial 3D contrast-enhanced T1-weighted fat-suppressed gradient-echo MR image shows the absence of enhancement in the synthetic material (arrows) within the urethral wall circumferentially. A urethral diverticulum can have a similar appearance with a lack of central enhancement (Adopted from Khatri et al., 2016) 6.3 Therapeutic outcomes Follow-up assessments showed significant improvement in the patient’s urinary incontinence symptoms, enhancing her overall quality of life. MRI confirmed precise placement of the collagen and its structural support to the urethra. Initially, the collagen appeared hyperintense on T2-weighted images due to its water content. Over
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