Abstract
PURPOSE: Defecating proctography and more recently, magnetic resonance imaging have both been used for diagnosis in patients with pelvic floor dysfunction. This pilot study assessed the feasibility of dynamic transperineal ultrasound in a range of specific disorders affecting evacuation. METHODS: A protocol of sagittal and transverse transperineal imaging was established defining the infralevator viscera and soft tissues and the margins of the puborectalis muscle. Dynamic measurements were possible for the extent of puborectalis shortening, the anorectal angle, and the movement during straining of the anorectal junction. Calculations were made of the depth of demonstrated rectoceles, the posterior urethrovesical angle, and the movement of the urethrovesical junction. Diagnoses were confirmed by proctography (where appropriate) and clinical examination. RESULTS: Transverse images of the anal sphincter were comparable with those obtained using endoanal ultrasonography. Sagittal images permitted the measurement of puborectalis contraction and the anorectal angle comparable with those obtained during defecography. Cystoceles were able to be diagnosed during closure of the posterior urethrovesical angle and abnormal urethrovesical junction descent during straining. Rectoceles, peritoneoceles, enteroceles, and rectoanal intussusception were readily identified using dynamic transperineal ultrasonography. CONCLUSION: Dynamic transperineal ultrasound is a simple, noninvasive way to assess dynamically the interaction of the pelvic viscera and their relationship to the pelvic floor musculature in patients with evacuatory disorders and pelvic floor dysfunction.
Similar content being viewed by others
References
DD Maglinte FM Kelvin K Fitzgerald DS Hale T Benson (1999) ArticleTitleAssociation of compartment defects in pelvic floor dysfunction AJR Am J Roentgenol 172 439–444
AC Weidner VH Low (1998) ArticleTitleImaging studies of the pelvic floor Obstet Gynecol Clin North Am 4 825–848
JC Healy S Halligan RH Reznek et al. (1997) ArticleTitleDynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement Br J Surg 11 1555–1558
A Lienemann C Anthuber A Baron P Kohz M Reiser (1997) ArticleTitleDynamic MR colpocystorectography assessing pelvic-floor descent Eur Radiol 7 1309–1317
R Goei G Kemerink (1990) ArticleTitleRadiation dose in defecography Radiology 176 137–139
JR Fielding DJ Griffiths E Versi RV Mulken ML Lee FA Jolesz (1998) ArticleTitleMR imaging of pelvic floor continence mechanisms in the supine and sitting positions AJR Am J Roentgenol 171 1607–1610
H Kleinübing SuffixJr JF Jannini O Malafaia S Brenner M Pinho (2000) ArticleTitleTransperineal ultrasonography Dis Colon Rectum 43 1572–1574
JC Healy S Halligan RH Reznek S Watson RK Phillips P Armstrong (1997) ArticleTitlePatterns of prolapse in women and symptoms of pelvic floor weakness Radiology 203 77–81
GN Schaer OR Koechli B Schuessler U Haller (1995) ArticleTitlePerineal ultrasound for evaluating the bladder neck in urinary stress incontinence Obstet Gynecol 85 220–224
TH Green (1975) ArticleTitleUrinary stress incontinence Am J Obstet Gynecol 122 368–400
P Mahieu J Pringot P Bodart (1984) ArticleTitleDefecography. 1. Description of a new procedure and results in normal patients Gastrointest Radiol 9 247–251
PJ Shorvon S McHugh NE Diamant S Somers GW Stevenson (1989) ArticleTitleDefecography in normal volunteers Gut 30 1737–1749
K Kenton S Shott L Brubaker (1999) ArticleTitleThe anatomic and functional variability in rectocele in women Int Urogynecol J Pelvic Floor Dysfunct 10 96–99
DJ Rubens JG Strang S Bogineni-Misra IE Wexler (1998) ArticleTitleTransperineal sonography of the rectum AJR Am J Roentgenol 170 637–642
UM Peschers JO DeLancey GN Schaer B Schuessler (1997) ArticleTitleExoanal ultrasound of the anal sphincter Br J Obstet Gynaecol 104 999–1003
H Koebl G Bernascheck J Deutinger (1990) ArticleTitleAssessment of female urinary incontinence by introital sonography J Clin Ultrasound 18 370–374
MJ Quinn J Beynon NJ Mortensen PJ Smith (1988) ArticleTitleTransvaginal endosonography Br J Urol 62 414–418
AC Poen RJ Felt-Bersma MA Cuesta GM Meuwissen (1998) ArticleTitleVaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis Br J Surg 85 359–363
JS Pittman JT Benson JE Sumners (1990) ArticleTitlePhysiologic evaluation of the anorectum Dis Colon Rectum 33 476–478
RJ Felt-Bersma WJ Luth JJ Janssen SG Meuwissen (1990) ArticleTitleDefecography in patients with anorectal disorders Dis Colon Rectum 33 277–284
HP Dietz PD Wilson (1999) ArticleTitleThe influence of bladder volume on the position and mobility of the urethrovesical junction Int Urogynecol J Pelvic Floor Dysfunct 10 3–6
A Lienemann C Anthuber A Baron M Reiser (2000) ArticleTitleDiagnosing enteroceles using dynamic magnetic resonance imaging Dis Colon Rectum 43 205–213
AW Schoenberger JF Debatin I Guldenschuh et al. (1998) ArticleTitleDynamic MR defecography with a superconducting, open-configuration MR system Radiology 206 641–646
Author information
Authors and Affiliations
About this article
Cite this article
Beer-Gabel, M., Teshler, M., Barzilai, N. et al. Dynamic Transperineal Ultrasound in the Diagnosis of Pelvic Floor Disorders. Dis Colon Rectum 45, 239–248 (2002). https://doi.org/10.1007/s10350-004-6155-7
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6155-7