Perineal pelvic floor ultrasound: applications and literature review

Pelvic floor dysfunction is highly prevalent. It encompasses conditions including pelvic organ prolapse, urinary incontinence, anal incontinence, obstructive defecation and sexual dysfunction. For the evaluation of pelvic floor dysfunction, translabial or transperineal ultrasound (TLUS) is increasingly used. A wealth of information can be obtained using a 2D B mode capable system for pelvic floor evaluation. However, three/four-dimensional imaging greatly enhances its utility, e.g. for the evaluation of synthetic implants used in urogynaecology, for the assessment of the levator ani and the hiatus, as well as for imaging of the anal sphincters. Compared to other imaging techniques the equipment for TLUS is widely available. The technique is non-invasive, easy and safe, involving no irradiation, and it has higher patient acceptance. Compared to CT and MRI the technique has superior temporal and spatial resolution, and it allows imaging of manoeuvres in real time. Using the same ultrasound system and transducer, a comprehensive pelvic floor assessment can be undertaken to facilitate patient counselling and management. Hence, TLUS is more likely than any other imaging techniques to have a positive impact on clinical practice and research in urogynaecology. This chapter describes clinical and research applications of TLUS. We will not cover the technical requirements as they will be described elsewhere. The indications for pelvic floor ultrasound include pelvic organ prolapse, obstructive defecation and urinary and anal incontinence. Other clinical conditions that may benefit from TLUS imaging, such as maternal birth trauma and complications after placement of synthetic implants, will also be covered.