Skip to main content

Instrumentation and Techniques for Perineal and Introital Pelvic Floor Ultrasound

  • Chapter
  • First Online:
Practical Pelvic Floor Ultrasonography

Abstract

This chapter describes instrumentation and techniques for pelvic floor ultrasound with introital and transperineal approaches. The reader will learn about the specific equipment, image orientation, and optimization, and details of 2D and 3D/4D imaging techniques. The chapter also describes different applications of the introital and transperineal imaging for evaluation of pelvic floor dysfunction, including pelvic floor biometry, pelvic floor hiatus and pelvic floor muscles evaluation, anal and urinary incontinence, and pelvic organ prolapse.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008;111(3):678–85.

    Article  PubMed  Google Scholar 

  2. Maglinte DD, Kelvin FM, Fitzgerald K, Hale DS, Benson JT. Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol. 1999;172(2):439–44.

    Article  CAS  PubMed  Google Scholar 

  3. Fielding JR, Griffiths DJ, Versi E, Mulkern RV, Lee ML, Jolesz FA. MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol. 1998;171(6):1607–10.

    Article  CAS  PubMed  Google Scholar 

  4. Goei R, Kemerink G. Radiation dose in defecography. Radiology. 1990;176(1):137–9.

    Article  CAS  PubMed  Google Scholar 

  5. Kohorn EI, Scioscia AL, Jeanty P, Hobbins JC. Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence. Obstet Gynecol. 1986;68(2):269–72.

    CAS  PubMed  Google Scholar 

  6. Creighton SM, Pearce JM, Stanton SL. Perineal video-ultrasonography in the assessment of vaginal prolapse: early observations. Br J Obstet Gynaecol. 1992;99(4):310–3.

    Article  CAS  PubMed  Google Scholar 

  7. Schaer GN, Koechli OR, Schuessler B, Haller U. Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol. 1995;85(2):220–4.

    Article  CAS  PubMed  Google Scholar 

  8. Kleinubing Jr H, Jannini JF, Malafaia O, Brenner S, Pinho TM. Transperineal ultrasonography: new method to image the anorectal region. Dis Colon Rectum. 2000;43(11):1572–4.

    Article  PubMed  Google Scholar 

  9. Tubaro A, Koelbl H, Laterza R, Khullar V, de Nunzio C. Ultrasound imaging of the pelvic floor: where are we going? Neurourol Urodyn. 2011;30(5):729–34.

    Article  PubMed  Google Scholar 

  10. Dietz HP. Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging. Ultrasound Obstet Gynecol. 2004;23(6):615–25.

    Article  CAS  PubMed  Google Scholar 

  11. Timor-Tritsch IE, Monteagudo A, Smilen SW, Porges RF, Avizova E. Simple ultrasound evaluation of the anal sphincter in female patients using a transvaginal transducer. Ultrasound Obstet Gynecol. 2005;25(2):177–83.

    Article  CAS  PubMed  Google Scholar 

  12. Weinstein MM, Jung SA, Pretorius DH, Nager CW, den Boer DJ, Mittal RK. The reliability of puborectalis muscle measurements with ultrasound imaging. Am J Obstet Gynecol. 2007;197(1):68.e1–6.

    Article  Google Scholar 

  13. Tunn R, Petri E. Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol. 2003;22(2):205–13.

    Article  CAS  PubMed  Google Scholar 

  14. Robinson D, Anders K, Cardozo L, Bidmead J, Toozs-Hobson P, Khullar V. Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms? BJOG. 2002;109:145–8.

    Article  PubMed  Google Scholar 

  15. Bai SW, Lee JW, Shin JS, Park JH, Kim SK, Park KH. The predictive values of various parameters in the diagnosis of stress urinary incontinence. Yonsei Med J. 2004;45(2):287–92.

    Article  PubMed  Google Scholar 

  16. Lukanovic A, Patrelli TS. Validation of ultrasound scan in the diagnosis of female stress urinary incontinence. Clin Exp Obstet Gynecol. 2011;38(4):373–8.

    CAS  PubMed  Google Scholar 

  17. Digesu GA, Calandrini N, Derpapas A, Gallo P, Ahmed S, Khullar V. Intraobserver and interobserver reliability of the three-dimensional ultrasound imaging of female urethral sphincter using a translabial technique. Int Urogynecol J. 2012;23(8):1063–8.

    Article  PubMed  Google Scholar 

  18. Athanasiou S, Khullar V, Boos K, Salvatore S, Cardozo L. Imaging the urethral sphincter with three-dimensional ultrasound. Obstet Gynecol. 1999;94(2):295–301.

    CAS  PubMed  Google Scholar 

  19. Shobeiri SA, Rostaminia G, White DE, Quiroz LH. The determinants of minimal levator hiatus and their relationship to the puborectalis muscle and the levator plate. BJOG. 2012;120(2):205–11.

    Article  PubMed  Google Scholar 

  20. Kim J, Ramanah R, DeLancey JOL, Ashton-miller JA. On the anatomy and histology of the pubovisceral muscle enthesis in women. Neurourol Urodyn. 2011;30:1366–70.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kruger JA, Heap SW, Murphy BA, Dietz HP. How best to measure the levator hiatus: evidence for the non-Euclidean nature of the ‘plane of minimal dimensions’. Ultrasound Obstet Gynecol. 2010;36(6):755–8.

    Article  CAS  PubMed  Google Scholar 

  22. Siafarikas F, Staer-Jensen J, Braekken I, Bo K, Engh ME. Learning process for performing and analysing 3/4D transperineal ultrasound imaging and inter-rater reliability study. Ultrasound Obstet Gynecol. 2013;41:312–7.

    Article  CAS  PubMed  Google Scholar 

  23. Jung SA, Pretorius DH, Padda BS, Weinstein MM, Nager CW, den Boer DJ, et al. Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol. 2007;197(1):52.e1–7.

    Article  Google Scholar 

  24. Dietz HP. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol. 2007;29(3):329–34.

    Article  CAS  PubMed  Google Scholar 

  25. Weinstein MM, Pretorius DH, Jung SA, Nager CW, Mittal RK. Transperineal three-dimensional ultrasound imaging for detection of anatomic defects in the anal sphincter complex muscles. Clin Gastroenterol Hepatol. 2009;7(2):205–11.

    Article  PubMed  Google Scholar 

  26. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46–53.. Epub 2003/01/09

    PubMed  PubMed Central  Google Scholar 

  27. Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12.

    Article  PubMed  Google Scholar 

  28. Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG. 2006;113(2):225–30.

    Article  CAS  PubMed  Google Scholar 

  29. Model AN, Shek KL, Dietz HP. Levator defects are associated with prolapse after pelvic floor surgery. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):220–3.

    Article  PubMed  Google Scholar 

  30. Dietz HP, Wilson PD, Clarke B. The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):166–8.. discussion 8–9

    Article  CAS  PubMed  Google Scholar 

  31. Choi JS, Wexner SD, Nam YS, Mavrantonis C, Salum MR, Yamaguchi T, et al. Intraobserver and interobserver measurements of the anorectal angle and perineal descent in defecography. Dis Colon Rectum. 2000;43(8):1121–6.

    Article  CAS  PubMed  Google Scholar 

  32. Padda BS, Jung SA, Pretorius D, Nager CW, Den-Boer D, Mittal RK. Effects of pelvic floor muscle contraction on anal canal pressure. Am J Physiol Gastrointest Liver Physiol. 2007;292(2):G565–71.

    Article  CAS  PubMed  Google Scholar 

  33. Roos AM, Abdool Z, Sultan AH, Thakar R. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: the PREDICT study. Clin Radiol. 2011;66(7):597–604.. Epub 2011/03/29

    Article  PubMed  Google Scholar 

  34. Kruger JA, Heap SW, Murphy BA, Dietz HP. Pelvic floor function in nulliparous women using three-dimensional ultrasound and magnetic resonance imaging. Obstet Gynecol. 2008;111(3):631–8.

    Article  CAS  PubMed  Google Scholar 

  35. Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25(6):580–5.

    Article  CAS  PubMed  Google Scholar 

  36. Jackson SL, Weber AM, Hull TL, Mitchinson AR, Walters MD. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 1997;89(3):423–7.

    Article  CAS  PubMed  Google Scholar 

  37. Bernstein IT. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies. Neurourol Urodyn. 1997;16(4):237–75.

    Article  CAS  PubMed  Google Scholar 

  38. Schuettoff S, Beyersdorff D, Gauruder-Burmester A, Tunn R. Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo. Ultrasound Obstet Gynecol. 2006;27(6):687–92.

    Article  CAS  PubMed  Google Scholar 

  39. Yalcin OT, Hassa H, Tanir M. A new ultrasonographic method for evaluation of the results of anti-incontinence operations. Acta Obstet Gynecol Scand. 2002;81(2):151–6.

    Article  PubMed  Google Scholar 

  40. Dietz HP, Wilson PD. The ‘iris effect’: how two-dimensional and three-dimensional ultrasound can help us understand anti-incontinence procedures. Ultrasound Obstet Gynecol. 2004;23(3):267–71.

    Article  CAS  PubMed  Google Scholar 

  41. Dietz HP, Mouritsen L, Ellis G, Wilson PD. How important is TVT location? Acta Obstet Gynecol Scand. 2004;83(10):904–8.

    Article  PubMed  Google Scholar 

  42. Ng CC, Lee LC, Han WH. Use of three-dimensional ultrasound scan to assess the clinical importance of midurethral placement of the tension-free vaginal tape (TVT) for treatment of incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):220–5.

    Article  PubMed  Google Scholar 

  43. Tunitsky-Bitton E, Unger CA, Barber MD, Goldman HB, Walters MD. Ultrasound evaluation of midurethral sling position and correlation to physical examination and patient symptoms. Female Pelvic Med Reconstr Surg. 2015;21(5):263–8.

    Article  PubMed  Google Scholar 

  44. Elia G, Bergman A. Periurethral collagen implant: ultrasound assessment and prediction of outcome. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(6):335–8.

    Article  CAS  PubMed  Google Scholar 

  45. Defreitas GA, Wilson TS, Zimmern PE, Forte TB. Three-dimensional ultrasonography: an objective outcome tool to assess collagen distribution in women with stress urinary incontinence. Urology. 2003;62(2):232–6.

    Article  PubMed  Google Scholar 

  46. Poon CI, Zimmern PE. Role of three-dimensional ultrasound in assessment of women undergoing urethral bulking agent therapy. Curr Opin Obstet Gynecol. 2004;16(5):411–7.

    Article  PubMed  Google Scholar 

  47. Unger CA, Barber MD, Walters MD. Ultrasound evaluation of the urethra and bladder neck before and after transurethral bulking. Female Pelvic Med Reconstr Surg. 2016;22(2):118–22.

    Article  PubMed  Google Scholar 

  48. Beer-Gabel M, Teshler M, Barzilai N, Lurie Y, Malnick S, Bass D, et al. Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders: pilot study. Dis Colon Rectum. 2002;45(2):239–45.. discussion 45–8

    Article  PubMed  Google Scholar 

  49. Dietz HP, Steensma AB. Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol. 2005;26(1):73–7.

    Article  CAS  PubMed  Google Scholar 

  50. Grasso RF, Piciucchi S, Quattrocchi CC, Sammarra M, Ripetti V, Zobel BB. Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography. Ultrasound Obstet Gynecol. 2007;30(1):86–94.

    Article  CAS  PubMed  Google Scholar 

  51. Weemhoff M, Kluivers KB, Govaert B, Evers JL, Kessels AG, Baeten CG. Transperineal ultrasound compared to evacuation proctography for diagnosing enteroceles and intussusceptions. Int J Colorectal Dis. 2013;28:359–63.

    Article  CAS  PubMed  Google Scholar 

  52. Broekhuis SR, Kluivers KB, Hendriks JC, Futterer JJ, Barentsz JO, Vierhout ME. POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(5):541–9.

    Article  PubMed  Google Scholar 

  53. Lone FW, Thakar R, Sultan AH, Stankiewicz A. Accuracy of assessing pelvic organ prolapse quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse. Int Urogynecol J. 2012;23(11):1555–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Milena M. Weinstein .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Weinstein, M.M., Van Delft, K.W.M., Abbas Shobeiri, S. (2017). Instrumentation and Techniques for Perineal and Introital Pelvic Floor Ultrasound. In: Shobeiri, S. (eds) Practical Pelvic Floor Ultrasonography. Springer, Cham. https://doi.org/10.1007/978-3-319-52929-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-52929-5_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52928-8

  • Online ISBN: 978-3-319-52929-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics