A Novel Ultrasound Technique Called Saline Infusion SonoPODography to Visualize and Understand the Pouch of Douglas and Posterior Compartment Contents: A Feasibility Study

Abstract

Women with infertility are often investigated with saline-infusion sonohysterography and hysterosalpingo-contrast-sonography. The high prevalence of endometriosis in this population also warrants an evaluation with transvaginal ultrasound for deep endometriosis. To minimize investigations, we prospectively evaluated the feasibility of a novel combined ultrasound technique called saline-infusion sonoPODography. In most patients, the fluid infused to assess the cavity and tubal patency spilled through patent tubes and filled the pouch of Douglas, yielding a "standoff" view of posterior compartment structures, including uterosacral ligaments, rectovaginal septum, and the pouch of Douglas. We believe this improved our ability to evaluate this space.

A pictorial guide to the ultrasound identification and assessment of uterosacral ligaments in women with potential endometriosis

“…Sometimes they are flush with the peritoneum on which the lesion is attached, making it nearly impossible to visualise on TVS. However, we propose that SE could be possibly visualised if there was fluid in the area of the lesion based on our experience with a feasibility study on a novel technique called saline‐infusion sonoPODography (SPG) . In the case of SPG, we artificially introduce fluid into the POD via the uterus and patent fallopian tubes.…”

Pathophysiology, diagnosis, and management of endometriosis

“…124 125 Saline infusion sonoPODography is a novel technique that may be able to diagnose superficial peritoneal endometriosis on ultrasonography, although it needs to be validated. 126…”

“…Although the sensitivity of transvaginal ultrasonography is maximized only for endometriomas, technological and training advances are improving detection of all sub-phenotypes of endometriotic lesions 124125. Saline infusion sonoPODography is a novel technique that may be able to diagnose superficial peritoneal endometriosis on ultrasonography, although it needs to be validated 126…”

Lessons from implementing the Australian National Action Plan for Endometriosis

“…This can exacerbate the diagnostic delay for patients with endometriosis, contributing to the ongoing costs for the patient and the healthcare system. Additional costs are incurred when surgery is intended to be diagnostic and therapeutic, but the therapeutic element is abandoned ( Leonardi et al 2019 b ). This regularly occurs when the endometriosis stage is more severe than anticipated and the surgeon does not have the necessary skill and/or the patient is inadequately consented for the necessary procedure.…”

“…Researchers have been researching novel strategies to overcome the current limitations of more rapid and affordable non-invasive diagnosis. These include devising ways to visualise the most difficult to diagnose superficial endometriosis and to combine the diagnostic potential of eTVUS and eMRIs, using artificial intelligence to create an algorithm that predicts the probability of a diagnosis of endometriosis ( Leonardi et al 2019 a , 2020 ). This hopes to alleviate some of the risks and accessibility issues faced by many people trying to obtain a timely diagnosis ( Surrey et al 2020 ).…”