Multiparametric comparative assessment of surgical efficacy in patients with SUI and POP versus normal controls.

To evaluate the anatomical outcomes of transobturator tension-free sling combined with posterior pelvic reconstruction in patients with stress urinary incontinence and pelvic organ prolapse using high-resolution magnetic resonance imaging. This study included 50 women with stage II POP and SUI who underwent the combined surgery, along with 10 matched healthy controls. Preoperative and postoperative pelvic floor morphology was assessed via MRI, measuring parameters including perineal body area, urethral length, levator hiatus dimensions, vaginal angles, and spatial coordinates of key anatomical landmarks. Postoperative MRI demonstrated significant restoration of pelvic floor anatomy: perineal body area increased (572.84 ± 90.42 mm² vs. preoperative 306.24 ± 90.33 mm², P < 0.001), urethral length extended (37.89 ± 4.70 mm vs. 31.58 ± 4.12 mm, P < 0.001), and levator hiatus parameters normalized. Vaginal axial deviations and landmark coordinates were effectively corrected, showing statistical improvement compared to preoperative values (P < 0.05) and restoration to levels comparable with controls. The TOT combined with posterior pelvic reconstruction effectively restores pelvic floor anatomy and biomechanical balance, providing an objective imaging basis for the anatomical restoration achieved by this procedure in treating SUI with POP.