Consensus Definitions and Interpretation Templates for Dynamic Ultrasound Imaging of Defecatory Pelvic Floor Disorders

Abstract

This document is a report of a "Proceedings" and not a formal society recommendation. Further, the document reflects clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Its content is not intended to be a substitute for professional medical judgment, diagnosis, or treatment. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient. The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to diagnosing and managing patients with pelvic floor conditions but approach evaluation and treatment of such patients with their unique perspectives given differences in their training. The PFDC was formed to enable collaboration between these specialties in developing and evaluating educational programs, creating clinical guidelines and algorithms, and promoting a high quality of care for this unique patient population. The recommendations included in this document represent the work of the PFDC Working Group on Ultrasound in Imaging of Defecatory Disorders of the Pelvic Floor (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners interested in considering pelvic floor ultrasound (PFUS) imaging in their assessment of defecatory pelvic floor disorders. STATEMENT OF THE PROBLEMDynamic PFUS has been shown to be an effective and relatively inexpensive method for evaluating pelvic organs, including the urethra, bladder, vagina, cervix and uterus, anal canal, rectum, and other pelvic floor structures such as the levator ani muscles. Pelvic floor ultrasound can be performed using transperineal/introital, endovaginal, or endoanal/endorectal approaches. There is considerable evidence for the use of PFUS imaging to quantify pelvic floor disorders. Still, there is significant variation across disciplines regarding the degree of utilization of PFUS for such indications and the preferred choice of specific PFUS technique. 1-4 Also, there is variability in the definitions of pathology described on PFUS between