Skip to main content
SpringerLink
Log in

Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy

  • Chapter
Pelvic Floor Disorders

Abstract

High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed evaluation of the pelvic floor muscles and the levator ani complex, the lower urinary tract, and the anorectal region in planes that cannot be determined by conventional two-dimensional EVUS. Multiplanar reconstruction and rendering techniques allow the investigator to correctly recognize and measure specific anatomic elements of the pelvic floor and to understand their true spatial relationships (anterior, lateral, and posterior compartments). This modality is relatively easy to perform and is time efficient, correlates well with other imaging modalities, and delivers relevant information in patients with pelvic floor disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Tunn R, Petri E. Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol 2003;22:205–213.

    Article  CAS  PubMed  Google Scholar 

  2. Sultan AH, Loder PB, Bartram CI et al. Vaginal endosonography. New approach to image the undisturbed anal sphincter. Dis Colon Rectum 1994;37:1296–1299.

    Article  CAS  PubMed  Google Scholar 

  3. Santoro GA, Fortling B. New technical developments in endoanal and endorectal ultrasonography. In: Santoro GA, Di Falco G (eds) Benign anorectal diseases. Diagnosis with endoanal and endorectal ultrasonography and new treatment options. Springer-Verlag Italy, Milan, 2006, pp 13–26.

    Google Scholar 

  4. Dietz HP, Steensma AB. Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol 2005;26:73–77.

    Article  CAS  PubMed  Google Scholar 

  5. Mitterberger M, Pinggera GM, Mueller T et al. Dynamic transurethral sonography and 3-dimensional reconstruction of the rhabdosphincter and urethra: initial experience in continent and incontinent women. J Ultrasound Med 2006; 25:315–320.

    PubMed  Google Scholar 

  6. Umek WH, Lami T, Stutterecker D et al. The urethra during pelvic floor contraction: observations on three-dimensional ultrasound. Obstet Gynecol 2002;100:796–800.

    Article  PubMed  Google Scholar 

  7. Santoro GA, Fortling B. The advantages of volume rendering in three-dimensional endosonography of the anorectum. Dis Colon Rectum 2007;50:359–368.

    Article  PubMed  Google Scholar 

  8. Santoro GA, Wieczorek AP, Stankiewicz A et al. High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study. Int Urogynecol J 2009;20:1213–1222.

    Article  Google Scholar 

  9. Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 2005; 25:580–585.

    Article  CAS  PubMed  Google Scholar 

  10. Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci 2007;1101:266–296.

    Article  PubMed  Google Scholar 

  11. DeLancey JOL, Hurd WW. Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol 1998;91:364–368.

    Article  CAS  PubMed  Google Scholar 

  12. Shobeiri SA, Chesson RR, Gasser RF. The internal innervation and morphology of the human female levator ani muscle. Am J Obstet Gynecol 2008;199:686.e1–6.

    Article  PubMed  Google Scholar 

  13. Kearney R, Sawhney R, DeLancey JO. Levator ani muscle anatomy evaluated by origin-insertion pairs. Obstet Gynecol 2004;104:168–173.

    PubMed  Google Scholar 

  14. Margulies RU, Hsu Y, Kearney R et al. Appearance of the levator ani muscle subdivisions in magnetic resonance images. Obstet Gynecol 2006;107:1064–1069.

    PubMed  Google Scholar 

  15. Shobeiri SA, LeClaire E, Nihira MA, et al. Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography. Obstet Gynecol 2009; 114: 66–72.

    PubMed  Google Scholar 

  16. Lien KC, Mooney B, DeLancey JO et al. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 2004;103:31–40.

    PubMed  Google Scholar 

  17. DeLancey JO. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 2005;192:1488–1495.

    Article  PubMed  Google Scholar 

  18. DeLancey JO, Morgan DM, Fenner DE et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 2007; 109:295–302.

    PubMed  Google Scholar 

  19. Tunn R, DeLancey JOL, Howard D et al. Anatomic variations in the levator ani muscle, endopelvic fascia and urethra in nulliparas evaluated by magnetic resonance imaging. Am J Obstet Gynecol 2003;188:116–121.

    Article  PubMed  Google Scholar 

  20. Dietz HP. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 2007;29:329–334.

    Article  CAS  PubMed  Google Scholar 

  21. DeLancey JO. Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 2002;187:93–98.

    Article  PubMed  Google Scholar 

  22. Dietz HP, Steensma AB, Hastings R. Three-dimensional ultrasound imaging of the pelvic floor: the effect of parturition on paravaginal support structures. Ultrasound Obstet Gynecol 2003;21:589–595.

    Article  CAS  PubMed  Google Scholar 

  23. Orno AK, Marsal K, Herbst A. Ultrasonographic anatomy of perineal structures during pregnancy and immediately fol lowing obstetric injury. Ultrasound Obstet Gynecol 2008; 32:527–534.

    Article  PubMed  Google Scholar 

  24. Umek WH, Kearney R, Morgan DM. The axial location of structural regions in the urethra: a magnetic resonance study in nulliparous women. Obstet Gynecol 2003;102:1039–1045.

    Article  PubMed  Google Scholar 

  25. Williams AB, Cheetham MJ, Bartram CI et al. Gender differences in the longitudinal pressure profile of the anal canal related to anatomical structure as demonstrated on three-dimensional anal endosonography. Br J Surg 2000;87:1674–1679.

    Article  CAS  PubMed  Google Scholar 

  26. Hall RJ, Rogers RG, Saiz L, Qualls C. Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid and distal levels. Int Urogynecol J 2007;18:881–888.

    Article  Google Scholar 

  27. Schaefer A, Enck P, Furst G et al. Anatomy of the anal sphincters. Comparison of anal endosonography to magnetic resonance imaging. Dis Colon Rectum 1994;37:777–781.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pelvic Floor Unit and Colorectal Service, 1st Department of General Surgery, Regional Hospital, Treviso, Italy

    Giulio Aniello Santoro MD

  2. Department of Pediatric Radiology, Children’s Teaching Hospital, Medical University of Lublin, Lublin, Poland

    Andrzej Paweł Wieczorek MD & Aleksandra Stankiewicz MD

  3. Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    S. Abbas Shobeiri MD

Authors
  1. Giulio Aniello Santoro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrzej Paweł Wieczorek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Abbas Shobeiri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aleksandra Stankiewicz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Pelvic Floor Unit and Colorectal Service 1st Department of General Surgery, Regional Hospital, Treviso, Italy

    Giulio Aniello Santoro (Head) (Head)

  2. Department of Pediatric Radiology Children’s Teaching Hospital, Skubiszewski Medical University of Lublin, Lublin, Poland

    Andrzej Paweł Wieczorek

  3. Diagnostic Imaging, Princess Grace Hospital, London, UK

    Clive I. Bartram

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Italia

About this chapter

Cite this chapter

Santoro, G.A., Wieczorek, A.P., Shobeiri, S.A., Stankiewicz, A. (2010). Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy. In: Santoro, G.A., Wieczorek, A.P., Bartram, C.I. (eds) Pelvic Floor Disorders. Springer, Milano. https://doi.org/10.1007/978-88-470-1542-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1542-5_7

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1541-8

  • Online ISBN: 978-88-470-1542-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation