The Use of Preoperative Defecography and Magnetic Resonance Imaging in Patients Undergoing Surgery for Primary Uterovaginal Prolapse: A Systematic Review.

INTRODUCTION AND HYPOTHESIS: The role of preoperative diagnostic testing, including preoperative defecography and magnetic resonance imaging (MRI) for women undergoing primary uterovaginal pelvic organ prolapse (U-POP) repair is not well described. Our primary objective was to evaluate the role of preoperative defecography and MRI for women undergoing surgery for U-POP. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we retrieved studies from MEDLINE and EMBASE in November 2025. Our population included women undergoing surgery for U-POP who underwent defecography or MRI as part of preoperative work-up. We evaluated indications for imaging, clinical utility of imaging in predicting surgical outcomes, and change in surgical planning based on imaging. Studies of all designs and in all languages were included if they had at least 30 patients with U-POP. Conference and video abstracts were excluded. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to assess the quality of the articles included. These data were used to create consensus guidelines, which were presented in-person at the U-POP consensus conference in Winston Salem, NC, USA on 20-21 April 2026. RESULTS: For the systematic review regarding the use of preoperative defecography, 174 abstracts were identified and 135 abstracts were screened yielding 3 studies that met the eligibility criteria and had Grade C to D level of evidence. There was no evidence for routine preoperative defecography in patients undergoing primary U-POP repair. For MRI, 576 abstracts were screened with 29 full-text results reviewed, 2 of which met Population, Intervention, Comparison, Outcomes and Study criteria. Results presented here are therefore summarized from the papers included and extrapolated from a broader urogynecology population. CONCLUSIONS: Based on limited existing evidence, the global consensus concluded that "clinicians should only consider defecography in the evaluation of patients with U-POP with symptoms of obstructed defecation." No consensus was reached on the optimal use of MRI in the preoperative evaluation of patients with U-POP.