Translabial Ultrasonography

  • Hans Peter Dietz
Chapter

Abstract

Translabial ultrasound is the most commonly used imaging method in the investigation of women with lower urinary tract symptoms and female pelvic organ prolapse, due to its simplicity, low cost and non-invasive nature. This chapter will summarize practical applications and recent research findings in this field. Pelvic floor ultrasound is helpful in the evaluation of anatomical findings in women with lower urinary tract symptoms, prolapse, and obstructed defecation, and it has enabled us to identify pathologies that were virtually unknown until very recently. The widespread application of cross-sectional imaging in female urology and urogynecology will allow us to improve current therapeutic options and to develop entirely new approaches, targeting underlying pathology rather than symptoms.

Keywords

Female pelvic organ prolapse Lower urinary tract Pelvic floor Ultrasound Urogynecology 
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References

  1. 1.
    Dietz H. Ultrasound imaging of the pelvic floor: part 1: 2D aspects. Ultrasound Obstet Gynecol 2004;23:80–92.PubMedCrossRefGoogle Scholar
  2. 2.
    Schaer GN, Siegwart R, Perucchini D, DeLancey JO. Examination of voiding in seated women using a remote-controlled ultrasound probe. Obstet Gynecol 1998;91:297–301.PubMedCrossRefGoogle Scholar
  3. 3.
    Pirpiris A, Shek K, Dietz HP. Urethral mobility and its relationship with urodynamic diagnosis. Neurourol Urodyn 2009;28:851–852.Google Scholar
  4. 4.
    Dietz HP, Bennett MJ. The effect of childbirth on pelvic organ mobility [comment]. Obstet Gynecol 2003;102:223–228.PubMedCrossRefGoogle Scholar
  5. 5.
    Shek KL, Dietz HP. The urethral motion profile: a novel method to evaluate urethral support and mobility. Aust N Z J Obstet Gynaecol 2008;48:337–342.PubMedCrossRefGoogle Scholar
  6. 6.
    Shek KL, Chantarasorn V, Dietz HP. The urethral motion profile before and after Monarc suburethral sling placement. Abstract. Annual Meeting of the International Continence Society, San Francisco, USA, 29 September to 3 October 2009.Google Scholar
  7. 7.
    Haylen BT, Frazer MI, Sutherst JR, West CR. Transvaginal ultrasound in the assessment of bladder volumes in women. Preliminary report. Br J Urol 1989;63:149–151.PubMedCrossRefGoogle Scholar
  8. 8.
    Schaer GN, Koechli OR, Schuessler B, Haller U. Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 1995;85:220–224.PubMedCrossRefGoogle Scholar
  9. 9.
    Dietz HP, Wilson PD. Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography. Int Urogynecol J 1998;9:365–369.CrossRefGoogle Scholar
  10. 10.
    Dietz HP, Wilson PD. The influence of bladder volume on the position and mobility of the urethrovesical junction. Int Urogynecol J 1999;10:3–6.CrossRefGoogle Scholar
  11. 11.
    Martan A, Masata J, Halaska M, Voigt R. Ultrasound imaging of the lower urinary system in women after Burch colposuspension. Ultrasound Obstet Gynecol 2001; 17:58–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Dietz HP, Eldridge A, Grace M, Clarke B. Pelvic organ descent in young nulligravid women. Am J Obstet Gynecol 2004;191:95–99.PubMedCrossRefGoogle Scholar
  13. 13.
    Oerno A, Dietz H. Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 2007;30:346–350.CrossRefGoogle Scholar
  14. 14.
    Reed H, Waterfield A, Freeman RM, Adekanmi OA. Bladder neck mobility in continent nulliparous women: normal references. Int Urogynecol J 2002;13:S4.CrossRefGoogle Scholar
  15. 15.
    Brandt FT, Albuquerque CD, Lorenzato FR, Amaral FJ. Perineal assessment of urethrovesical junction mobility in young continent females. Int Urogynecol J 2000;11:18–22.CrossRefGoogle Scholar
  16. 16.
    Peschers UM, Fanger G, Schaer GN et al. Bladder neck mobility in continent nulliparous women. BJOG 2001; 108:320–324.PubMedCrossRefGoogle Scholar
  17. 17.
    Dietz HP, Hansell N, Grace M et al. Bladder neck mobility is a heritable trait. Br J Obstet Gynaecol 2005;112:334–339.Google Scholar
  18. 18.
    Peschers U, Schaer G, Anthuber C et al. Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol 1996;88:1001–1006.PubMedCrossRefGoogle Scholar
  19. 19.
    Dietz HP, Clarke B, Vancaillie TG. Vaginal childbirth and bladder neck mobility. Aust N Z J Obstet Gynaecol 2002;42:522–525.PubMedCrossRefGoogle Scholar
  20. 20.
    Huang WC, Yang JM. Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology 2003;61:936–941.PubMedCrossRefGoogle Scholar
  21. 21.
    Masata J, Martan A, Halaska M et al. Ultrasound imaging of urethral funneling. Int Urogynecol J 1999;10(suppl):S62.Google Scholar
  22. 22.
    Dietz HP, Clarke B. The urethral pressure profile and ultrasound parameters of bladder neck mobility. Int Urogynecol J 1998;17:374–375.Google Scholar
  23. 23.
    Dietz HP, McKnoulty L, Clarke B. Translabial color Doppler for imaging in urogynecology: a preliminary report. Ultrasound Obstet Gynecol 1999;14:144–147.PubMedCrossRefGoogle Scholar
  24. 24.
    Dietz HP, Clarke B. Translabial color Doppler urodynamics. Int Urogynecol J 2001;12:304–307.CrossRefGoogle Scholar
  25. 25.
    Masata J, Martan A, Halaska M et al. Detection of Valsalva leak point pressure with colour Doppler-new method for routine use. Neurourol Urodyn 2001;20:494–496.Google Scholar
  26. 26.
    Dietz HP, Haylen BT, Vancaillie TG. Female pelvic organ prolapse and voiding function. Int Urogynecol J 2002;13:284–288.CrossRefGoogle Scholar
  27. 27.
    Eisenberg V, Chantarasorn V, Dietz HP. Avulsion defect and cystocele: is there a link? Ultrasound Obstet Gynecol 2009;3(suppl 1):8.CrossRefGoogle Scholar
  28. 28.
    Tsai M, Tsai K, Liu C et al. Perineal ultrasonography in diagnosing anterior vaginal leiomyoma resembling a cystocele. Ultrasound Obstet Gynecol 2007;30:1013–1014.PubMedCrossRefGoogle Scholar
  29. 29.
    Khullar V, Cardozo L. Imaging in urogynaecology. Br J Obstet Gynaecol 1996;103:1061–1067.PubMedGoogle Scholar
  30. 30.
    Yang JM, Huang WC. Bladder wall thickness on ultrasonographic cystourethrography: affecting factors and their implications. J Ultrasound Med 2003;22:777–782.PubMedGoogle Scholar
  31. 31.
    Lekskulchai O, Dietz H. Detrusor wall thickness as a test for detrusor overactivity in women. Ultrasound Obstet Gynecol 2008;32:535–539.PubMedCrossRefGoogle Scholar
  32. 32.
    Robinson D, Anders K, Cardozo L et al. Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms? BJOG 2002;109:145–148.PubMedCrossRefGoogle Scholar
  33. 33.
    Robinson D, Khullar V, Cardozo L. Can bladder wall thickness predict postoperative detrusor overactivity? Int Urogynecol J 2005;16:S106.Google Scholar
  34. 34.
    Lekskulchai O, Dietz HP. Is detrusor hypertrophy in women associated with voiding dysfunction? Aust N Z J Obstet Gynaecol 2009;49:653–666.PubMedCrossRefGoogle Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    Dietz HP, Korda A. Which bowel symptoms are most strongly associated with a true rectocele? Aust N Z J Obstet Gynaecol 2005;45:505–508.PubMedCrossRefGoogle Scholar
  37. 37.
    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 2010;202:321–334.Google Scholar
  38. 38.
    Perniola G, Shek K, Chong CC et al. Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol 2007;31:567–571.CrossRefGoogle Scholar
  39. 39.
    Dietz HP. Pelvic floor ultrasound: a review. Am J Obstet Gynecol 2010;202:321–334.PubMedCrossRefGoogle Scholar
  40. 40.
    Steensma AB, Oom DMJ, Burger CW, Schouten WR. Comparison of defecography and 3D/ 4D translabial ultrasound in patients with pelvic organ prolapse and/ or evacuation disorders. Ultrasound Obstet Gynecol 2007;30:447.CrossRefGoogle Scholar
  41. 41.
    Konstantinovic ML, Steensma AB, Domali E et al. Correlation between 3D/4D translabial ultrasound and colpocystodefecography in diagnosis of posterior compartment prolapse. Ultrasound Obstet Gynecol 2007;30:448.CrossRefGoogle Scholar
  42. 42.
    Grasso R, Piciucchi S, Quattrocchi C et al. Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography. Ultrasound Obstet Gynecol 2007;30:86–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Peschers UM, DeLancey JO, Schaer GN, Schuessler B. Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol 1997;104:999–1003.PubMedGoogle Scholar
  44. 44.
    Kleinubing H, Jr., Jannini JF, Malafaia O et al. Transperineal ultrasonography: new method to image the anorectal region. Dis Colon Rectum 2000;43:1572–1574.PubMedCrossRefGoogle Scholar
  45. 45.
    Yagel S, Valsky DV. Three-dimensional transperineal sonography for evaluation of the anal sphincter complex: another dimension in understanding peripartum sphincter trauma. Ultrasound Obstet Gynecol 2006;27:119–123.PubMedCrossRefGoogle Scholar
  46. 46.
    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.CrossRefGoogle Scholar
  47. 47.
    Lee J, Pretorius D, Weinstein MM et al. Transperineal threedimensional ultrasound in evaluating anal sphincter muscles. Ultrasound Obstet Gynecol 2007;30:201–209.PubMedCrossRefGoogle Scholar
  48. 48.
    Dietz HP. Pelvic floor ultrasound. Australasian Society for Ultrasound Medicine Bulletin 2007;10:17–23.Google Scholar
  49. 49.
    Cornelia L, Stephan B, Michel B et al. Trans-perineal versus endo-anal ultrasound in the detection of anal sphincter tears. Eur J Obstetrics Gynecol Reprod Biol 2002;103:79–82.CrossRefGoogle Scholar
  50. 50.
    Dietz HP, Chantarasorn V, Shek KL. Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 2010;accepted 1.12.09.Google Scholar
  51. 51.
    Bombieri L, Freeman RM, Perkins EP et al. Why do women have voiding dysfunction and de novo detrusor instability after colposuspension? Br J Obstet Gynaecol 2002; 109:402–412.Google Scholar
  52. 52.
    Dietz HP, Wilson PD, Clarke B, Haylen BT. Irritative symptoms after colposuspension: are they due to distortion or overelevation of the anterior vaginal wall and trigone? Int Urogynecol J 2001;12:232–235; discussion 235-236.CrossRefGoogle Scholar
  53. 53.
    Dietz H, Wilson P. Laparoscopic colposuspension vs. urethropexy: a case control series. Int Urogynecol J 2005;16:15–18; discussion 18.CrossRefGoogle Scholar
  54. 54.
    Dietz HP, Wilson PD. Colposuspension success and failure: a long-term objective follow-up study. Int Urogynecol J 2000;11:346–351.CrossRefGoogle Scholar
  55. 55.
    Bombieri L, Freeman RM, Perkins EP et al. Objective assessment of bladder neck elevation and urethral compression at colposuspension. BJOG 2002;109:395–401.PubMedCrossRefGoogle Scholar
  56. 56.
    Viereck V, Pauer HU, Bader W et al. Introital ultrasound of the lower genital tract before and after colposuspension: a 4-year objective follow-up. Ultrasound Obstet Gynecol 2004;23:277–283.PubMedCrossRefGoogle Scholar
  57. 57.
    Dietz H, Wilson P. Long-term success after open and laparoscopic colposuspension: a case control study. Gyn Endoscopy 2002;11:81–84.CrossRefGoogle Scholar
  58. 58.
    Dietz H, Barry C, Lim Y, Rane A. TVT vs Monarc: a comparative study. Int Urogynecol J 2006;17:566–569.CrossRefGoogle Scholar
  59. 59.
    Dietz HP, Barry C, Lim YN, Rane A. Two-dimensional and three-dimensional ultrasound imaging of suburethral slings. Ultrasound Obstet Gynecol 2005;26:175–179.PubMedCrossRefGoogle Scholar
  60. 60.
    Schuettoff S, Beyersdorff D, Gauruder-Burmester A, Tunn R. Visibility of the polypropylene tape after TVT (tension-free vaginal tape) procedure in women with stress urinary incontinence: comparison of introital ultrasound and MRI in vitro and in patients. Ultrasound Obstet Gynecol 2006; 27:687–692.PubMedCrossRefGoogle Scholar
  61. 61.
    Dietz HP, Wilson PD. The “iris effect”: how two-dimensional and three-dimensional ultrasound can help us understand anti-incontinence procedures. Ultrasound Obstet Gynecol 2004;23:267–271.PubMedCrossRefGoogle Scholar
  62. 62.
    Masata J, Martan A, Svabik K et al. Ultrasound imaging of the lower urinary tract after successful tension-free vaginal tape (TVT) procedure. Ultrasound Obstet Gynecol 2006; 28:221–228.PubMedCrossRefGoogle Scholar
  63. 63.
    Dietz HP, Mouritsen L, Ellis G, Wilson PD. How important is TVT location? Acta Obstet Gynecol Scand 2004;83:904–908.PubMedGoogle Scholar
  64. 64.
    de Tayrac R, Deffieux X, Resten A et al. A transvaginal ultrasound study comparing transobturator tape and tensionfree vaginal tape after surgical treatment of female stress urinary incontinence. Int Urogynecol J 2006;17:466–471.CrossRefGoogle Scholar
  65. 65.
    Ng C, Lee L, Han H. Use of three-dimensional ultrasound scan to assess the importance of midurethral placement of the tension-free vaginal tape (TVT) for treatment of incontinence. Int Urogynecol J 2006;16:220–225.CrossRefGoogle Scholar
  66. 66.
    Dietz HP, Mouritsen L, Ellis G, Wilson PD. Does the tension-free vaginal tape stay where you put it? Am J Obstet Gynecol 2003;188:950–953.PubMedCrossRefGoogle Scholar
  67. 67.
    Harms L, Emons G, Bader W et al. Funneling before and after anti-incontinence surgery — a prognostic indicator? Part 2: tension-free vaginal tape. Int Urogynecol J 2007; 18:189–294.CrossRefGoogle Scholar
  68. 68.
    Tunn R, Gauruder-Burmester A, Koelle D. Ultrasound diagnosis of intra-urethral tension-free vaginal tape (TVT) position as a cause of postoperative voiding dysfunction and retropubic pain. Ultrasound Obstet Gynecol 2004;23:298–301.PubMedCrossRefGoogle Scholar
  69. 69.
    Chantarasorn V, Shek KL, Dietz HP. Sonographic appearance of transobturator slings: implications for function and dysfunction. Abstract. Annual Meeting of the Internation Continence Society, San Francisco, 29 September to 3 October 2009.Google Scholar
  70. 70.
    Jurgens J, Steller J. Theoretisch-mathematische Modelle zur Kräftewirkung bei alloplastischen Bandsystemen in der Inkontinenztherapie. Gynäkol Geburtshilfliche Rundsch 2005;45:257–261.PubMedCrossRefGoogle Scholar
  71. 71.
    Shek KL, Dietz HP, Rane A, Balakrishnan S. Transobturator mesh repair for large and recurrent cystocele. Ultrasound Obst Gynecol 2008;32:82–86.CrossRefGoogle Scholar
  72. 72.
    Tunn R, Picot A, Marschke J, Gauruder-Burmester A. Sonomorphological evaluation of polypropylene mesh implants after vaginal mesh repair in women with cystocele or rectocele. Ultrasound Obstet Gynecol 2007;29:449–452.PubMedCrossRefGoogle Scholar
  73. 73.
    Svabik K, Martan A, Masata J, ElHaddad R. Vaginal mesh shrinking-ultrasound assessment and quantification. Int Urogynecol J 2009;20:S166.Google Scholar
  74. 74.
    Erdmann M, Shek K, Dietz H. Mesh contraction: myth or reality? Int Urogynecol J 2010; in print.Google Scholar
  75. 75.
    Shek C, Rane A, Goh JTW, Dietz HP. Stress urinary incontinence after transobturator mesh for cystocele repair. Int Urogynecol J 2009;20:421–425.CrossRefGoogle Scholar
  76. 76.
    Gainey HL. Post-partum observation of pelvic tissue damage. Am J Obstet Gynecol 1943;46:457–466.Google Scholar
  77. 77.
    DeLancey JO, Kearney R, Chou Q et al. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 2003;101:46–53.PubMedCrossRefGoogle Scholar
  78. 78.
    Dietz H, Steensma A. The prevalence of major abnormalities of the levator ani in urogynaecological patients. Br J Obstet Gynaecol 2006;113:225–230.Google Scholar
  79. 79.
    Dietz H, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005;106:707–712.PubMedGoogle Scholar
  80. 80.
    Dietz H, Gillespie A, Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol 2007; 47:341–344.PubMedCrossRefGoogle Scholar
  81. 81.
    Abdool Z, Shek K, Dietz H. The effect of levator avulsion on hiatal dimensions and function. Am J Obstet Gynecol 2009;201:89.e1–89.e5.CrossRefGoogle Scholar
  82. 82.
    Athanasiou S, Chaliha C, Toozs-Hobson P et al. Direct imaging of the pelvic floor muscles using two-dimensional ultrasound: a comparison of women with urogenital prolapse versus controls. BJOG 2007;114:882–888.PubMedCrossRefGoogle Scholar
  83. 83.
    Dietz HP, Shek KL. Levator trauma can be diagnosed by 2D translabial ultrasound. Int Urogynecol J 2009;20:807–811.CrossRefGoogle Scholar
  84. 84.
    Dietz HP. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynaecol 2007;29:329–334.CrossRefGoogle Scholar
  85. 85.
    Dietz HP, Simpson J. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115:979–984.PubMedCrossRefGoogle Scholar
  86. 86.
    DeLancey J, Morgan D, Fenner D et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 2007; 109:295–302.PubMedGoogle Scholar
  87. 87.
    Dietz HP, Shek C. Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J 2008;19:633–636.CrossRefGoogle Scholar
  88. 88.
    Sarma S, Hersch M, Siva S et al. Women who cannot contract their pelvic floor muscles: avulsion or denervation? Neurourol Urodyn 2009;28(suppl 1):680–681.Google Scholar
  89. 89.
    Adekanmi OA, Freeman R, Puckett M, Jackson S. Cystocele: does anterior repair fail because we fail to correct the fascial defects? A clinical and radiological study. Int Urogynecol J 2005;16:S73.CrossRefGoogle Scholar
  90. 90.
    Model A, Shek KL, Dietz HP. Do levator defects increase the risk of prolapse recurrence after pelvic floor surgery? Neurourol Urodyn 2009;28(suppl 1):888–889.Google Scholar
  91. 91.
    Dietz HP, Shek KL. Validity and reproducibility of the digital detection of levator trauma. Int Urogynecol J 2008;19:1097–1101.CrossRefGoogle Scholar
  92. 92.
    Dietz HP, Hyland G, Hay-Smith J. The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound. Neurourol Urodyn 2006;25:424–427.PubMedCrossRefGoogle Scholar
  93. 93.
    Kearney R, Miller JM, Delancey JO. Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 2006;25:50–54.PubMedCrossRefGoogle Scholar
  94. 94.
    Dietz H. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 2007; 29:329–334.PubMedCrossRefGoogle Scholar
  95. 95.
    Weinstein MM, Pretorius D, Nager CW, Mittal R. Inter-rater reliability of pelvic floor muscle imaging abnormalities with 3D ultrasound. Ultrasound Obstet Gynecol 2007;30:538.CrossRefGoogle Scholar
  96. 96.
    Dietz H, Abbu A, Shek K. The levator urethral gap measurement: an objective means of determining levator avulsion? Ultrasound Obstet Gynecol 2008;32:941–945.PubMedCrossRefGoogle Scholar
  97. 97.
    Singh K, Jakab M, Reid W et al. Three-dimensional magnetic resonance imaging assessment of levator animorphologic features in different grades of prolapse. Am J Obstet Gynecol 2003;188:910–915.PubMedCrossRefGoogle Scholar
  98. 98.
    Dietz HP, Kirby A, Shek KL, Bedwell P. Does avulsion of puborectalis muscle affect bladder function? Int Urogynecol J 2009;20:967–972.CrossRefGoogle Scholar
  99. 99.
    Chantarasorn V, Shek KL, Dietz HP. Levator avulsion is not associated with fecal incontinence. Int Urogynecol J 2009;20(suppl 2):S169–170.Google Scholar
  100. 100.
    Weinstein MM, Pretorius D, Jung SY et al. Anatomic defects in the puborectalis muscle in women with fecal incontinence. Ultrasound Obstet Gynecol 2007;30:637.CrossRefGoogle Scholar
  101. 101.
    Steensma AB, Schweitzer KJ, Burger CW, Schouten WR. Are anal sphincter injuries related to levator abnormalities? Ultrasound Obstet Gynecol 2007;30:448.CrossRefGoogle Scholar
  102. 102.
    Dietz H, Shek K, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 2005;25:580–585.PubMedCrossRefGoogle Scholar
  103. 103.
    Wong V, Shek KL, Dietz HP. A simplified method for the determination of levator hiatal dimensions. Int Urogynecol J 2009;20(suppl 2):S145–156.Google Scholar
  104. 104.
    Yang J, Yang S, Huang W. Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrsound Obstet Gynecol 2006;26:710–716.CrossRefGoogle Scholar
  105. 105.
    Hoff Braekken I, Majida M, Ellstrom Engh M et al. Testretest and intra-observer reliability of two-three-and fourdimensional perineal ultrasound of pelvic floor muscle anatomy and function. Int Urogynecol J 2008;227–235.Google Scholar
  106. 106.
    Guaderrama N, Liu J, Nager C et al. Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol 2006;106:774–781.Google Scholar
  107. 107.
    Kruger J, Dietz H, Murphy B. Pelvic floor function in elite nulliparous athletes and controls. Ultrasound Obstet Gynecol 2007;30:81–85.PubMedCrossRefGoogle Scholar
  108. 108.
    Kruger J, Heap X, Dietz HP. A comparison of MRI and ultrasound in the assessment of the levator hiatus. Ultrasound Obstet Gynecol 2007;30:447.CrossRefGoogle Scholar
  109. 109.
    Dietz HP, Shek KL, De Leon J, Steensma A. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 2008;31:676–680.PubMedCrossRefGoogle Scholar
  110. 110.
    Kruger J, Heap X, Murphy B, Dietz H. Pelvic floor function in nulliparous women using 3-dimensional ultrasound and magnetic resonance imaging. Obstet Gynecol 2008;111:631–638.PubMedGoogle Scholar
  111. 111.
    Lanzarone V, Dietz H. 3-Dimensional ultrasound imaging of the levator hiatus in late pregnancy and associations with delivery outcomes. Aust N Z J Obstet Gynaecol 2007; 47:176–180.PubMedCrossRefGoogle Scholar
  112. 112.
    Balmforth J, Toosz-Hobson P, Cardozo L. Ask not what childbirth can do to your pelvic floor but what your pelvic floor can do in childbirth. Neurourol Urodyn 2003;22:540–542.Google Scholar
  113. 113.
    Shek KL, Chantarasorn V, Dietz HP. Can levator avulsion be predicted antenatally? Accepted, Am J Obstet Gynecol 15.9.09.Google Scholar
  114. 114.
    Svabik K, Shek KL, Dietz HP. How much does the puborectalis muscle have to stretch in childbirth? BJOG 2009; 116:1657–1662.PubMedCrossRefGoogle Scholar
  115. 115.
    Dietz H, Steensma A. Dimensions of the levator hiatus in symptomatic women. Ultrasound Obstet Gynecol 2005; 26:369–370.CrossRefGoogle Scholar
  116. 116.
    Barry C, Dietz H, Lim Y, Rane A. A short-term independent audit of mesh repair for the treatment of rectocele in women, using 3-dimensional volume ultrasound: a pilot study. Aust N Z Continence J 2006;12:94–99.Google Scholar
  117. 117.
    Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions: a prospective observational study. Obstet Gynecol 2009;113:1272–1278.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Hans Peter Dietz
    • 1
  1. 1.Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School-NepeanUniversity of SydneySydneyAustralia

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