Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele

Dietz, Hans Peter; Steensma, Anneke B.

doi:10.1002/uog.1930

Cited by 163 publications

(152 citation statements)

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“…Thus, while some reports have correlated pelvic floor abnormalities with obstetric trauma (4,10,12,23) , others have failed to identify an association between the incidence of such dysfunctions and vaginal delivery (17,20,27) . According to Dietz et al (6,7) true rectocele is a rectovaginal septum defect in younger nulliparous women, the prevalence and size of which appear to be associated with childbirth. Regadas et al (21) clearly demonstrated gender-specific differences in anal canal anatomy.…”

Section: Resultsmentioning

confidence: 99%

“…Different techniques and imaging methods have been used to evaluate pelvic floor dysfunctions in the anterior, middle and posterior compartment (2,3,7,8,9,12,14,15,16,17,18,19,20,24,25,27) . Because of differences in measurement techniques and anatomical landmarks, some authors describe rectocele as a descent of the rectal ampulla, quantified by correlation with the inferoposterior margin of the symphysis pubis (8,12) , while others consider rectocele a herniation of the anterior rectal wall into the posterior vagina, the size of which determines the grade of rectocele (2,3,9,13,15,17,19,20,23,27,29) .…”

Section: Resultsmentioning

confidence: 99%

“…However, the relation between vaginal delivery, age (post-menopause) and posterior pelvic floor dysfunctions involving obstructed defecation syndrome (ODS) is still a matter of controversy (8,14,17,19,27) . Pelvic floor dysfunctions are best evaluated with dynamic techniques such as magnetic resonance (9,15) and ultrasonography using endorectal (2,18,19) or transperineal (3,7) probes to view the anal canal and pelvis anatomy. Thus, echodefecography, a 3-D dynamic anorectal ultrasonography technique recently developed by Murad-Regadas et al (19) , may be used to evaluate voiding disorders affecting the posterior compartment (rectocele, rectal intussusception, anismus)…”

Section: Introductionmentioning

confidence: 99%

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Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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-Context -The correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. Objectives -To determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. Methods -Four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3D ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade II or III, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade III). In addition, sphincter damage was evaluated. Patients were grouped according to age (≤50y x >50y) and stratified by mode of delivery and parity: group I (≤50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group II (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. Additionally, patients were stratified by number of vaginal deliveries: 0 -nulliparous (n = 135), 1 -vaginal (n = 46), >1 -vaginal (n = 166). Results -Rectocele grade II or III, intussusception, rectocele + intussusception and sphincter damage were more prevalent in Group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001). The stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. Entero/sigmoidocele was more prevalent in the vaginal group ≤50y and in the nulliparous and vaginal groups >50y. No correlation was found between rectocele and the number of vaginal deliveries. Conclusion -Higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. However, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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“…TLUS provides two-dimensional (2D) imaging of the pelvic floor. In the midsagittal plane, all anatomical structures (bladder, urethra, vaginal walls, anal canal and rectum) between the posterior surface of the symphysis pubis and the posterior part of the levator ani are visualized [7]. …”

mentioning

confidence: 99%

“…This dynamic modality allows assessment of pelvic organ prolapse, perineal descent or pelvic floor dyssynergy. Using 3D volumetric probes developed for obstetric imaging, 3D-and 4D-TLUS may be performed [7]. An advantage of this technique, compared with 2D mode, is the opportunity to obtain tomographic or multislice imaging, for example in the axial plane, in order to assess the entire puborectalis muscle and its attachment to the pubic rami.…”

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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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Imaging modalities for the detection of posterior compartment disorders in women with obstructed defaecation syndrome

Gruting

Stankiewicz

Thakar

et al. 2015

Cochrane Database of Systematic Reviews

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Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele

Abstract: Objectives

Cited by 163 publications

References 13 publications

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Imaging the pelvic floor

Imaging modalities for the detection of posterior compartment disorders in women with obstructed defaecation syndrome

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