Dynamic Transperineal Sonography

DETECTION OF PELVIC FLOOR PATHOLOGY

Recipient of the Best Clinical Presentation Award ASUM 1998 Annual Scientific Meeting (revised May 2009)

INTRODUCTION

This paper described non-invasive ultrasound technique which may enhance, or in some practices provide a cheaper alternative to other methods of imaging pelvic floor dynamics.

Women who have had multiple vaginal deliveries and pelvic surgery are more likely to exhibit pelvic floor dysfunction resulting in urinary or fecal incontinence. Dynamic cystography and MRI DPFs have been the traditional standard in analysing pelvic floor dynamics and the causes of incontinence . In 2008 Christchurch Radiology Group conducted approximately 435 scans of the pelvic floor and anal sphincter and 197 cystograms in order to investigate patients with varying problems.

Literature has described the uses of ultrasound in evaluating urethral, anorectal, and vaginal / perineal tissues in women and children. Recent articles  focus on the transperineal technique highlighting its simplicity and effectiveness at evaluating the pathology in this area. In 1998 we added a valsalva manoeuvre to this technique to demonstrate abnormalities caused by damage to the pelvic floor musculature and evaluated the role and usefulness of Dynamic Transperineal Sonography in the diagnosis of the cause, or causes, of urinary and fecal incontinence.

TECHNIQUE

Transperineal sonography is performed using a linear array graduated frequency transducer on patients referred for fecal or urinary disturbances.

Patients lie in the dorsal lithotomy position. Images are obtained longitudinally in the midline of the urethra and vagina, and the anal sphincter. Parasagittal views are only taken if considered necessary eg; where masses are seen. Longitudinal midline views were taken during valsalva. Axial images were obtained in the caudal, mid and superior sections of the anal canal and a single axial section through the vaginal region during valsalva.

RESULTS

Bladder and rectal prolapses are easily identified by excessive movement of the bladder and rectum inferiorly toward the probe through the pelvic floor musculature.

Anal sphincter tears particularly of the inner ring are easily identified and quantified using this method.

We concluded at the time of the original study that ultrasound provided a safe , non invasive and relatively inexpensive alternative to cystography and DPFs particularly where prolapse or anal sphincter damage is suspected.

Shirley Curgenven

Charge Sonographer