Functional Imaging of the Pelvic Floor

Abstract

The clinical treatment of patients with anorectal and pelvic floor dysfunction is often difficult. Dynamic cystocolpoproctography (DCP) has evolved from a method of evaluating the anorectum for functional disorders to its current status as a functional method of evaluating the global pelvic floor for defecatory disorders and pelvic organ prolapse. It has both high observer accuracy and a high yield of positive diagnoses. Clinicians find it a useful diagnostic tool that can alter management decisions from surgical to medical and vice versa in many cases. Functional radiography provides the maximum stress to the pelvic floor, resulting in levator ani relaxation accompanied by rectal emptying-which is needed to diagnose defecatory disorders. It also provides organ-specific quantificative information about female pelvic organ prolapse-information that usually can only be inferred by means of physical examination. The application of functional radiography to the assessment of defecatory disorders and pelvic organ prolapse has highlighted the limitations of physical examination. It has become clear that pelvic floor disorders rarely occur in isolation and that global pelvic floor assessment is necessary. Despite the advances in other imaging methods, DCP has remained a practical, cost-effective procedure for the evaluation of anorectal and pelvic floor dysfunction. In this article, the authors describe the technique they use when performing DCP, define the radiographic criteria used for diagnosis, and discuss the limitations and clinical utility of DCP.

Diagnostic Effectiveness of Dynamic Colpocystoproctography in Women Planning for Combined Surgery with Urinary Incontinence and Pelvic Organ Prolapse

“…Each participant underwent a DCP per the following protocol [4,6,17,18]. Instruct patient to retain the suppository for at least 10 min.…”

“…Dynamic colpocystodefecography began at rest and continued sequentially through the straining, voiding, and defecation phases. In older patients and in patients with fecal soiling, it has been suggested that the squeeze sequence done first and the strain sequence eliminated so insure a diagnostic functional sequence [6]. To avoid bladder compression, rectal filling was performed after the voiding phase in patients who exhibited rectoceles during the physical examination.…”

“…Such an approach is dependent on the accurate preoperative identification of POP [6]. Although the factors leading to failure of surgical repair are not well understood and multifactorial, it appears that the limitations of physical examination in diagnosing all POPs may lead to incomplete surgeries and may contribute to the high reoperation rate [7].…”

“…dMRI has the advantages of no radiation exposure, high resolution of soft tissue when MR coils are used [8], and multiple imaging axes; DCP, sometimes called DCP or cystocolpoenterodefecography, is distinguished by its use of actual defecation and voiding to induce POP [9,10,11,12,13,14,15]. Recently, functional imaging for POP is warranted and DCP is one of the recommended diagnostic methods [6]. Although several studies have reported benefits of DCP, its role in the diagnosis of UI and POP remains undocumented.…”

Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction

“…8,9 Defaecatory imaging may be poorly tolerated and findings should be interpreted with caution. [10][11][12] Integrated total pelvic ultrasound (endoanal, transvaginal, transperineal) 13 allows dynamic multicompartmental pelvic floor assessment with simultaneous endoanal assessment of the anal sphincter complex and is cheap, safe, portable and well tolerated. 12,14,15 While treatment options for pelvic floor defaecatory dysfunction are continually developing, the assessment algorithm also requires refinement.…”