Newer Dimensions in the Evaluation of Pelvic Pathology B Y Transperineal Ultrasonography

Abstract

BACKGROUND: Pelvic floor dysfunction is one of the common conditions encountered in female patient's especially uterine descent; cystocele and rectocele are faced by elderly parous women. At present there is no fixed ultrasound criteria to evaluate the pelvic floor. About 11-15% of the general populations who attend outpatient department suffer from various degrees of these problems. Ultrasound imaging of pelvic floor will help the patient from unnecessary complications and reduce the morbidity by delineating pelvic floor anatomy with dynamic studies. OBJECTIVES: To define pelvic floor ultrasound anatomy and to define fixed criteria for diagnosis of problems by 2D ultrasound and to apply the same to qualify and quantify problems. METHODS: Prospective ultrasonographic analysis of sequentially selected 50 cases presenting with pelvic floor dysfunction, and diagnosed clinically by gynecologists were included. INTERPRETATION AND CONCLUSION:Ultrasound is an invaluable, minimally invasive, highly accurate and cost effective procedure for assessment of pelvic floor movement of uterus, bladder and rectum with strain is best assessed on real time ultrasound. INTRODUCTION:Pelvic floor weakness and organ prolapse is relatively common condition in middle aged and elderly parous women that can have a significant impact on quality of life. 1, 2 Pelvic organ prolapse typically demonstrates multiple abnormalities and may involve uterus, the urethra, bladder, vaginal vault, rectum and small bowel. Patients may present with pain, pressure, urinary and fecal incontinence, constipation, urinary retention and defecatory dysfunction. Till date diagnosis was made primarily on the basis of findings at physical pelvic examination and history. 2 New imaging technology offers an opportunity to objectively assess the pathology and improve our follow up of patients and so obtain a better estimation of the true incidence of unsuccessful operations and postoperative complication.High resolution dynamic transperineal ultrasound provide superior depiction of the pelvic anatomy and also help in understanding pathologic and functional changes that occur in pelvic floor disorders. Ultrasound has found more widespread use which provides excellent resolution and contrast, because of cost and it also offers a degree of dynamic imaging that is not currently achievable by other modalities. B mode ultrasonography is universally available and provides for real time observation of maneuvers such as valsalva and pelvic floor muscle contraction. We have seen 50 cases and were able to delineate various abnormalities. METHODS:To start with we have to understand basics of ultrasound technique which will be possible only if we are able to simplify the anatomy. The use of transabdominal ultrasound in the evaluation of lower urinary tract and pelvic floor dysfunction was first documented in the early