Perineal body anatomy seen by three‐dimensional endovaginal ultrasound of asymptomatic nulliparae

Santoro, G. A.; Shobeiri, S. Abbas; Petros, Peter; Zapater, Pedro; Wieczorek, Paweł

doi:10.1111/codi.13119

Cited by 29 publications

(27 citation statements)

References 44 publications

(147 reference statements)

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“…This method of scanning the perineal body gives the clearest images observed so far in the literature. Previous studies had shown poor repeatability [10,11]. This may be because, in those studies, the perineal body was measured on images that acquired the entire pelvic floor.…”

Section: Discussionmentioning

confidence: 98%

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Ultrasound imaging of the perineal body: a useful clinical tool

et al. 2019

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Introduction and hypothesis The perineal body is a fibromuscular pyramidal structure located between the vagina and the anus. It has been difficult to image because of its small size and anatomical location. This study used 2D transperineal ultrasound to measure the perineal body and assess whether there is an association with prolapse. Methods An observational, cross-sectional study was carried out in a tertiary level Urogynaecology department and included prolapse patients and healthy nulliparous volunteers (control group). This was a clinical assessment, including POP-Q and transperineal 2D ultrasound measurement of the perineal body height, length, perimeter, and area. Parametric tests were used, as the data were normally distributed. Results are reported as mean and 95% confidence interval (±95% CI). Results A total of 101 participants were recruited of which 22 were nulliparous healthy volunteers. Mean perineal body measurements in controls were height 22.5 ± 3.3 mm, length 17.4 ± 2.7 mm, perimeter 7.5 ± 0.9 mm, and area 2.8 ± 0.38 cm 2. Perineal body measurements in 79 prolapse patients: height 16.9 ± 1.7 mm, length 16.0 ± 1.4 mm, perimeter 6.5 ± 0.5 mm and area 2.1 ± 0.5 cm 2. A small perineal body was strongly associated with posterior compartment prolapse (paired t test, p < 0.0001) and wider POP-Q GH (paired t test, p = 0.0003). Surprisingly, Pelvic Organ Prolapse Quantification Perineal Body (POP-Q PB) of the two groups was not significantly different. A perineal body mid-sagittal area of less than 2.4 cm 2 has been shown to be associated strongly with posterior compartment prolapse. Conclusions It is possible to measure the perineal body on 2D ultrasound. This technique facilitates the objective diagnosis of perineal deficiency. POP-Q PB does not predict the length or area of the perineal body.

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Section: Discussionmentioning

confidence: 98%

“…In 2016, the perineal body of nulliparous cadavers was visualised using a three-dimensional endovaginal ultrasound ((3D-EVUS) BK high frequency ultrasound scanner, with 3D Viewer offline analysis [11]. In the EVUS scan, the perineal body is visualised as an ovoid structure.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound imaging of the perineal body: a useful clinical tool

et al. 2019

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“…Three‐Dimensional EVUS Once the transducer is advanced to visualize the anterior compartment as in Figure , the 3D volume is obtained. The scan starts from the vesicourethral junction and will continue 6 cm caudal to include the perineal body . The 3D volume is useful for visualization of the levator ani muscle subdivisions and defects, vaginal masses and cysts, slings, and mesh (Figure ) .…”

Section: Specifications Of the Examinationmentioning

confidence: 99%

AIUM/IUGA Practice Parameter for the Performance of Urogynecological Ultrasound Examinations: Developed in Collaboration with the ACR, the AUGS, the AUA, and the SRU

2019

J of Ultrasound Medicine

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he clinical aspects of this parameter were developed by the AIUM/IUGA Collaborative Committee in collaboration with other organizations whose members use ultrasound for performing pelvic floor examinations (see "Acknowledgments"). Recommendations for practitioner requirements, the written request for the examination, procedure documentation, and quality control vary among the organizations and are addressed by each separately.An ultrasound examination is a proven and useful procedure for evaluating the pelvic floor, including the urethra, bladder, vagina, uterus if possible, anorectum, and levator ani muscle. Pelvic floor ultrasound (PFUS) examinations should be performed only when there is a valid medical reason. The lowest possible ultrasonic exposure settings should be used to gain the necessary diagnostic information. Although it is not possible to detect all pelvic floor pathology, adherence to the following practice parameter will maximize the possibility of detecting many conditions.

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“…Axial images of the pelvis with high frequency 3D EVUS (9-16 MHz) are similar to those with 3D TPUS, however, the higher frequency provides better resolution of the examined structures [24]. High resolution 3D EVUS allows an accurate evaluation of the symmetry between urethra and the anal canal, the morphology of the urethra (rhabdosphincter, lisosphincter) and of the supporting ligaments and fascia [25], the levator ani muscle subdivisions [26], the indices of levator hiatus (area, length and width) 27], the integrity of the perineal body and the rectovaginal fascia [28], the post-operative evaluation of tapes and meshes to identify displacement, shrinkage, fluid collections, abscesses or hematomas (Figs. 2-3).…”

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confidence: 99%

Beyond Imagination: Integrated Imaging Approach to Pelvic Floor Disorders

Santoro

2020

Koloproktologiâ

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Pelvic floor disorders (PFD) represents a significant social and economic problem involving about 25% of women older than 60 years with a 13% lifetime risk of undergoing surgery for PFD. Optimal management is impossible without comprehensive assessment of pelvic floor and multimodal approach. A combination of ultrasonic methods has several advantages (low cost, wide accessibility and availability, office procedure performed by clinicians, intraoperative technique, relatively time consuming, good compliance) and should be performed as first-line assessment in PFD.

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Perineal body anatomy seen by three‐dimensional endovaginal ultrasound of asymptomatic nulliparae

Abstract: The PB is divided into two levels with different anatomical relationships with the pelvic floor muscles. 3D-EVUS yields reproducible assessment of this complex structure.

Cited by 29 publications

References 44 publications

Ultrasound imaging of the perineal body: a useful clinical tool

Ultrasound imaging of the perineal body: a useful clinical tool

AIUM/IUGA Practice Parameter for the Performance of Urogynecological Ultrasound Examinations: Developed in Collaboration with the ACR, the AUGS, the AUA, and the SRU

Beyond Imagination: Integrated Imaging Approach to Pelvic Floor Disorders

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