Contemporary Review of MRI in Benign Genitourinary Pelvic Medicine: What Every Urologist Should Know

Purpose of Review: Herein we report a systematic review of literature to identify the contemporary focus areas of magnetic resonance imaging (MRI) use in benign Urology and present the highest yield results. Recent Findings: MRI, specifically upright MRI, in combination with proper instructions and repeated Valsalva maneuvers, allows for more objective assessment of pelvic organ prolapse (POP) staging. The lack of standardization of reference lines and points used in MRI evaluation of POP is a key limitation. Evaluation of prostate artery embolization (PAE) as an effective treatment for benign prostatic hyperplasia (BPH) was a key focus of recent studies, but clear data regarding ideal patient population, procedure standardization, and performance compared to TURP are still lacking. A longer membranous urethral length (MUL) measured on MRI was predictive of post-prostatectomy continence. Dynamic MRI of the vesicourethral junction provided insight into the development of stress urinary incontinence (SUI) and the factors that contribute to successful treatment with a sling. Functional MRI demonstrated that localization of the defective signaling mechanism in women with overactive bladder (OAB) determines their likelihood to respond to pelvic floor muscle training. Patients with both neurogenic and non-neurogenic LUT dysfunction show abnormalities in both grey and white brain matter compared to healthy individuals, especially in the pontine micturition center and periaqueductal grey. Summary: MRI has become an indispensable tool in benign Urology with its applicability in diagnosis, prediction, and prognosis of the disease at the organ level (bladder, prostate, urethra) and beyond (brain).