High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study

Santoro, G. A.; Wieczorek, Paweł; Stankiewicz, Aleksandra; Woźniak, Magdalena; Bogusiewicz, Michał; Rechberger, Tomasz

doi:10.1007/s00192-009-0928-4

Cited by 86 publications

(80 citation statements)

References 26 publications

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“…The transducer was inserted into the vagina in a neutral position with the patient lying in the supine position with knees partially flexed. The EVUS was performed according to the protocol previously reported by Santoro et al 8 The acquisition began from the bladder neck and terminated beyond the transverse perinei muscles. The reference point of the symmetry was fixed at the junction of the rami of the SP (Gothic arch) located at 12 o'clock on the screen.…”

Section: Ethics Approvalmentioning

confidence: 99%

“…High-resolution 3D-EVUS is also easy to use in outpatient settings, and images are acquired at rest. We used a standardized technique which has been described by Santoro et al 8 Detection of LAM avulsion is possible using 2D-TPUS. 19 Maximum valsalva manoeuvre can be used to identify an enlarged hiatus.…”

Section: Techniquementioning

confidence: 99%

“…3 However, concerns have been raised regarding decisions based on clinical assessment alone, as this may have a limited role in evaluating the morphological and structural changes leading to PFD. 4,5 A review of the literature revealed that the majority of morphologic features of the female genital tract can be identified using ultrasound [6][7][8][9][10][11] and MRI. 12, 13 Dietz et al 6 first described the use of translabial ultrasound to quantify POP and demonstrated a good correlation between imaging, clinical staging and POPQ.…”

Section: Introductionmentioning

confidence: 99%

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Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Lone¹,

Sultan²,

Stankiewicz³

et al. 2016

BJR

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Objective: To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using twodimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360°rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. Results: 158 females had PFUS assessment. Good-toexcellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Conclusion: Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. Advances in knowledge: We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.

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Section: Ethics Approvalmentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Lone¹,

Sultan²,

Stankiewicz³

et al. 2016

BJR

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“…By using the same 360°rotational mechanical probe as used for EAUS, this procedure provides 3D high-resolution images of the anatomical structures of the pelvic floor [13]. It allows assessment of female urethral complex [14], biometric indices of the levator hiatus [15], damage of the levator ani [16], endopelvic fascia and/or the perineal body [17].…”

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confidence: 99%

Imaging the pelvic floor

Santoro

2017

Tech Coloproctol

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Urinary and fecal incontinence, obstructed defecation, pelvic pain and pelvic organ prolapse are common in older multiparous women, affecting approximately 16% of females aged 40-56 years [1]. As we evaluate a patient with a clinically evident anatomic defect (rectocele, rectal prolapse, perineal descent), it is essential to establish whether this defect is really associated with the patient's symptoms (obstructed defecation). Moreover, a pelvic floor disorder in one compartment frequently coexists with disorders involving other compartments. Indeed, rather than considering the pelvic floor as divided into three vertical compartments, the current concept is to approach the pelvic floor as a horizontal structure [1]. The pelvic floor is a three-dimensional mechanical apparatus that acts as a unit, with a close interrelationship between organ systems, fascia and ligaments, muscles, vessels and nerves. Because the levator ani muscle provides support to all three organ systems, its weakness will result in impaired function of any, or all, of the structures that the muscle supports. In addition, damage to the endopelvic, pubocervical or rectovaginal fascias will lead to herniation of one organ system into another. This is demonstrated by the common coexistence of prolapse of the anterior and posterior vaginal walls requiring repair of both. Understanding pelvic floor anatomy is therefore crucial for an effective management of these dysfunctions.A careful preoperative evaluation is key to determining the pathophysiology of pelvic floor dysfunction [2]. Clinical examination, however, is not accurate in diagnosing anatomical defects of the posterior vaginal wall, overestimating the presence of rectocele (large false-positive rate) but missing enterocele or intussusception in patients with primary pelvic organ prolapse (large false-negative rate) [3,4]. Imaging allows the clinician to better evaluate the patients in order to determine what anatomical alterations are present, and this leads to appropriate surgical interventions and increased success rates [5]. Traditional evacuation proctography or colpocystoproctography, modern dynamic magnetic resonance imaging and ultrasound can be used for visualization of the pelvic floor [5]. Advantages of ultrasound over the other imaging modalities are that it is more widely available, more cost-effective, less time-consuming, and associated with better patient compliance. It is performed by the clinician during office consultation and can be considered as an extension of the physical examination. The development of new technological innovations such as three-/four-dimensional (3D/4D) tools, video-recording, post-processing analysis and the standardization of methodology and terminology [6] have made ultrasound imaging more reproducible and less operator dependent.Several ultrasound techniques can be used to assess the pelvic floor [6]. Translabial ultrasound (TLUS) is performed with the patient placed in the dorsal lithotomy position, with hips flexed and abducted, by using a con...

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“…3 However, concerns have been raised regarding decisions based on clinical assessment alone, as this may have a limited role in evaluating the morphological and structural changes leading to PFD. 4,5 A review of the literature shows that the majority of morphologic studies of the female genital tract have been conducted using ultrasound [6][7][8][9][10][11] highlighted the benefits of an integrated approach to PF ultrasonography (PFUS). In addition, PFUS can provide information that may affect operative decisions.…”

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confidence: 99%

The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study

Lone¹,

Sultan²,

Stankiewicz³

et al. 2014

BJR

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Objective: Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies. Methods: Females were recruited from the urogynaecology/ gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360°r otational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently.Results: 158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition. Conclusion: Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS. Advances in knowledge: PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment.

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High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study

Abstract: 3D-EVUS allows measurements of key pelvic floor structures in planes that cannot be determined by conventional imaging modalities.

Cited by 86 publications

References 26 publications

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Imaging the pelvic floor

The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study

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