Female perineal diseases: spectrum of imaging findings

Ssi-Yan-Kai, G.; Thubert, Thibault; Rivain, A L; Prévôt, Sophie; Deffieux, X.; Laveaucoupet, J. De

doi:10.1007/s00261-015-0427-7

Cited by 6 publications

(3 citation statements)

References 43 publications

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“…Ultrasonographic features of the lesion are usually similar to those observed with perineal ultrasonography with the advantage that it better reveals the involvement of the anal sphincter ( 10 ). Even if only 6.1% of the patients in this review benefited from this exam, magnetic resonance imaging (MRI) could become the modality of choice for perineal imaging ( 117 , 118 ) as pelvic MRI has greater sensitivity (90–92%) and specificity (91–98%) for the diagnosis of endometriomas when compared to other non-invasive methods ( 119 , 120 ). Vulvo-perineal localizations are easily identified on T1-weighted fat-suppressed images as hyper-intense spots within the perineum.…”

Section: Discussionmentioning

confidence: 99%

“…Vulvo-perineal localizations are easily identified on T1-weighted fat-suppressed images as hyper-intense spots within the perineum. Multilobular mass with inner hemorrhage, localized or diffuse vulvovaginal wall thickening, hemorrhagic or spiculated masses and distortion can also be observed ( 94 , 117 ). MRI also helps in assessing the extent of the anal sphincter involvement ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

et al. 2021

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Objective: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate.Methods: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria.Results: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, n = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies).Conclusion: In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

et al. 2021

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“…Magnetic resonance imaging (MRI) can produce high resolution multiplanar images of the perineum and can be used in the diagnosis and staging of perineal tumors or complex trauma. 21 MRI studies on pelvic floor anatomy in pregnant and parous women may provide excellent threedimensional (3D) images of the anatomy. 18,22,23 However, studies assessing obstetric perineal lacerations or episiotomies on MRI are lacking.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Perineal Scars on Translabial Pelvic Floor Ultrasound: A Pilot Study

Housmans

Gillor

Shek

et al. 2022

J of Ultrasound Medicine

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Objective We aimed to describe a method for identifying and evaluating perineal scars using translabial pelvic floor ultrasound. We hypothesized that translabial ultrasound can identify a perineal scar and can differentiate episiotomies from spontaneous tears. Methods This pilot study is a secondary analysis of data obtained in the Epi‐No® trial. Perineal integrity was assessed using volumes acquired on pelvic floor muscle contraction according to the method previously described for anal sphincter imaging. A scar was diagnosed if a hypoechoic distortion in the perineum was noted. We postulated that an episiotomy would result in a linear scar visible on four dimensional translabial ultrasound whereas nonlinear scars were considered the result of spontaneous perineal tear of grade 2 or higher. The results of this assessment were compared with data retrieved from electronic medical records. Results A scar was identified in 79/120 women (66%): 42 (35%) linear and 37 (31%) nonlinear. Sonographic and clinical diagnosis agreed on the presence or absence of perineal trauma in 66%. Agreement for the type of laceration was 50%. Conclusion In this retrospective pilot study, a blinded assessment of translabial ultrasound volume data showed agreement between clinical data and sonographic assessment of perineal integrity in 66% and of type of laceration in 50%. More work is needed to optimize the method in assessment of perineal scars to improve its performance before it can be used in clinical audit and research.

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Vagina and Vulva

Tsili

2017

MRI and CT of the Female Pelvis

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Female perineal diseases: spectrum of imaging findings

Cited by 6 publications

References 43 publications

Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

Assessment of Perineal Scars on Translabial Pelvic Floor Ultrasound: A Pilot Study

Vagina and Vulva

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