Obstet Gynecol Sci.  2023 Mar;66(2):69-75. 10.5468/ogs.22227.

Translabial ultrasound for pelvic organ prolapse

Affiliations
  • 1Department of Obstetrics and Gynecology, King Faisal Medical City for Southern Regions, Al Marooj, Abha, Saudi Arabia
  • 2Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Pelvic organ prolapse (POP) is a significant public health concern in women and a common cause of gynecological surgery in elderly women. The prevalence of POP has increased with an increase in the aging population. POP is usually diagnosed based on pelvic examination. However, an imaging study may be necessary for more accurate diagnosis. Translabial ultrasound (TLUS) was used to assess diverse types of POP, particularly posterior-compartment POP. It is beneficial to distinguish between true and false rectocele, and detect the rectocele as clinically apparent. TLUS can also establish whether the underlying cause is a problem of the rectovaginal septum, perineal hypermobility, or isolated enterocele. TLUS also plays a role in differentiating POP from conditions that mimic POP. It is a simple, inexpensive, and non-harmful diagnostic modality that is appropriate for most gynecologic clinics.

Keyword

Enterocele; Pelvic organ prolapse; Rectocele; Ultrasonography

Figure

  • Fig. 1 (A) Application of a convex transducer to labium minora for translabial ultrasonography. (B) Symphysis pubis, urethra, bladder, uterus, vagina, cul-de-sac, rectum, rectal ampulla, and colon are visible on translabial ultrasound. (C) Two-dimensional view of the midsagittal plane of the pelvic floor. The main structures identified on this plane are, from left to right, symphysis pubis (SP), urethra (U), urinary bladder (UB), vagina (V), rectum (R) and the puborectalis muscle (PR) passing behind the rectum [18].

  • Fig. 2 Avulsion injury detected on a three-dimensional transperineal ultrasound image of women with pelvic organ prolapse. The yellow dashed circle includes the avulsion injury structure [34].

  • Fig. 3 Translabial ultrasonography (A) in the resting phase. Rectovaginal septum (arrowheads). Translabial ultrasonography in patients with (B) rectocele and (C) enterocele in maximal Valsalva phase. Rectocele filled with stool and air, resulting in hyper echogenicity, and the defect of the rectovaginal septum is observed in the maximal Valsalva maneuver (B). The contents of an enterocele generally appear iso- to hyperechogenic compared with a rectocele, and bowel peristalsis is usually observed in the enterocele sac (C) [2]. PS, pubis symphysis; V, vagina; AC, anal canal; U, urethra; RA, rectal ampulla; B, bladder; R, rectocele; E, enterocele.


Reference

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