Skip to main content
SpringerLink
Log in

Endoluminal Ultrasonography

  • Chapter
Pelvic Floor Disorders

Abstract

The pathophysiology of pelvic organ prolapse (POP) is complex. The most common mechanisms underlying pelvic floor disorders are represented by damages to the connective tissue supporting the pelvic organs and to the levator ani muscle occurring during childbirth. Management of POP still seems to be guided largely by personal preferences and experience rather than evidence-based medicine. Diagnostic tests frequently result in a revised initial management plan; however, no guidelines exist concerning their optimal use in a clinical practice setting, and their use as a routine strategy appears not to be an option. The advent of high-resolution three-dimensional ultrasonography and dynamic ultrasonography has improved our understanding of pelvic floor function. On the basis of ultrasonographic findings, additional tests may be performed in selected conditions to optimize treatment planning and to identify the reason for surgical failure.

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. Kerkhof MH, Hendriks L, Brolmann HA. Changes in connective tissue in patients with pelvic organ prolapse — a review of the current literature. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:461–474.

    Article  PubMed  CAS  Google Scholar 

  2. Hsu Y, Chen L, Huebner M et al. Quantification of levator ani cross-sectional area differences between women with and those without prolapse. Obstet Gynecol 2006;108: 879–883.

    Article  PubMed  Google Scholar 

  3. Dietz HP. The aetiology of prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:1323–1329.

    Article  PubMed  CAS  Google Scholar 

  4. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 2004;191:1533–1538.

    Article  PubMed  Google Scholar 

  5. Stoker J, Halligan S, Bartram CI. Pelvic floor imaging. Radiology 2001;218:621–641.

    PubMed  CAS  Google Scholar 

  6. Maglinte DDT, Bartram C. Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography. Techniques, indications, results and limitations. Eur J Radiol 2007;61:454–461.

    Article  PubMed  Google Scholar 

  7. Mortele KJ, Fairhurst J. Dynamic MR defecography of the posterior compartment: Indications, techniques and MRI features. Eur J Radiol 2007;61:462–472.

    Article  PubMed  Google Scholar 

  8. Huebner M, Margulies RU, De Lancey JOL. Pelvic architectural distortion is associated with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:863–867.

    Article  PubMed  Google Scholar 

  9. Tunn R, Schaer G, Peschers U. Update recommendations on ultrasonography in urogynecology. Int Urogynecol J 2005;16:236–241.

    Article  CAS  Google Scholar 

  10. Majida M, Brekken IH, Umek W et al. Interobserver repeability of three-and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function. Ultrasound Obstet Gynecol 2009;33:567–573.

    Article  PubMed  CAS  Google Scholar 

  11. Broekhuis SR, Kluivers KB, Hendriks JC et al. POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct 2009;20:541–549.

    Article  Google Scholar 

  12. 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 Pelvic Floor Dysfunct 2009;20: 1213–1222.

    Article  PubMed  Google Scholar 

  13. Stankiewicz A, Wieczorek AP, Wozniak MM et al. Comparison of accuracy of functional measurements of the urethra in transperineal vs. endovaginal ultrasound in incontinent women. Pelviperineology 2008;27:145–147.

    Google Scholar 

  14. Singh K, Jakab M, Reid W et al. Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse. Am J Obstet Gynecol 2003;188:910–915.

    Article  PubMed  Google Scholar 

  15. 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 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Tunn R, DeLancey JO, 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 

  18. Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 2006;113:225–230.

    Article  PubMed  CAS  Google Scholar 

  19. 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  PubMed  CAS  Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. Olsen AL, Smith VJ, Bergstrom JO et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501–506.

    Article  PubMed  CAS  Google Scholar 

  22. Mellgren A, Bremmer S, Johansson C et al. Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 1994;37:1133–1141.

    Article  PubMed  CAS  Google Scholar 

  23. Maglinte DD, Kelvin FM, Fitzgerald K et al. Association of compartment defects in pelvic floor dysfunction. Am J Roentgenol 1999;172:439–444.

    CAS  Google Scholar 

  24. Kelvin FM, Maglinte DD, Benson JT et al. Dynamic cystoproctography: a technique for assessing disorders of the pelvic floor in women. Am J Roentgenol 1994;163:368–370.

    CAS  Google Scholar 

  25. Kenton K, Shott S, Brubaker L. Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse. Int Urogynecol J 1997;8:336–339.

    Article  CAS  Google Scholar 

  26. Perniola G., Shek C, Chong CCW et al. Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol 2008;31:567–571.

    Article  PubMed  CAS  Google Scholar 

  27. Steensma AB, Oom DMJ, Burger CW, Rudolph Schouten W. Assessment of posterior compartment prolapse; a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis 2009;29 April epub ahead of print.

    Google Scholar 

  28. Murad Regadas SM, Regadas FSP, Rodrigues LV et al. A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation: a comparison with defecography. Surg Endoscopy 2008;22:974–979.

    Article  Google Scholar 

  29. Broden B, Snellman B. Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum 1968;11:330–347.

    Article  PubMed  CAS  Google Scholar 

  30. Shorvon PJ, McHugh S, Diamant NE et al. Defecography in normal volunteers: results and implications. Gut 1989;30:1737–1749.

    Article  PubMed  CAS  Google Scholar 

  31. Halligan S, Sultan A, Rottenberg G et al. Endosonography of the anal sphincters in solitary rectal ulcer syndrome. Int J Colorectal Dis 1995;10:79–82.

    Article  PubMed  CAS  Google Scholar 

  32. Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome. Dis Colon Rectum 1985;28:669–672.

    Article  PubMed  CAS  Google Scholar 

  33. Vimplis S, Hooper P. Assessment and management of pelvic organ prolapse. Curr Obstet Gynecol 2005;15:387–393.

    Article  Google Scholar 

  34. Altman D, Lopez A, Kierkegaard J et al. Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography. Int Urogynecol J 2005;16:96–103.

    Article  Google Scholar 

  35. Broekhuis SR, Futterer JJ, Hendriks JCM et al. Symptoms of pelvic floor dysfunction are poorly correlated with findings on clinical examination and dynamic MR imaging of the pelvic floor. Int Urogynecol J 2009; 20:1169–1174.

    Article  Google Scholar 

  36. Hetzer FH, Andreisek G, Tsagari C et al. MR defecography in patients with fecal incontinence and their effect on surgical management. Radiology 2006;240:449–457.

    Article  PubMed  Google Scholar 

  37. Kaufman HS, Buller JL, Thompson JR et al. Dynamic pelvic magnetic resonance imaging and cystocolpodefecography alter surgical management of pelvic floor disorders. Dis Colon Rectum 2001;44:1575–1584.

    Article  PubMed  CAS  Google Scholar 

  38. Groenendijk AG, Birnie E, de Blok S et al. Clinical-decision taking in primary pelvic organ prolapse; the effects of diagnostic tests on treatment selection in comparison with a consensus meeting. Int Urogynecol J 2009;20:711–719.

    Article  Google Scholar 

  39. Groenendijk AG, Birnie E, Boeckxstaens GE et al. Anorectal function testing and anal endosonography in the diagnostic work-up of patients with primary pelvic organ prolapse. Gynecol Obstet Invest 2009;67:187–194.

    Article  PubMed  Google Scholar 

  40. Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 2001;18:511–514.

    Article  PubMed  CAS  Google Scholar 

  41. Groenendijk AG, van der Hulst VP, Birnie E, Bonsel GJ. Correlation between posterior vaginal wall defects assessed by clinical examination and by defecography. Int Urogynecol J 2008;19:1291–1297.

    Article  Google Scholar 

  42. Harvey CJ, Halligan S, Bartram CI et al. Evacuation proctography: a prospective study of diagnostic and therapeutic effects. Radiology 1999;211:223–227.

    PubMed  CAS  Google Scholar 

  43. Finco C, Savastano S, Luongo B et al. Colpocystodefecography in obstructed defecation: is it really useful to the surgeon? Correlating clinical and radiological findings in surgery for obstructed defecation. Colorectal Dis 2007;10:446–452.

    Article  PubMed  Google Scholar 

  44. Kluivers KB, Hendriks JCM, Shek C, Dietz HP. Pelvic organ prolapse symptoms in relation to POP-Q, ordinal stages and ultrasound prolapse assessment. Int Urogynecol J 2009; 19:1299–1302.

    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, Magdalena Maria Woźniak MD & Aleksandra Stankiewicz 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. Magdalena Maria Woźniak 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., Woźniak, M.M., Stankiewicz, A. (2010). Endoluminal Ultrasonography. 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_54

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1542-5_54

  • 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