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Functional Imaging in Rectal Prolapse

  • Vittorio Luigi Piloni
  • Alberto Bazzocchi
  • Rita Golfieri

Abstract

Imaging data has gained great relevance in the preoperative assessment of severe pelvic organ prolapse, including vaginal vault descent, enterocele, rectocele and cystocele. This is at least partly due to inaccurate characterisation and failure to identify all of the involved sites when using physical examination alone, leading to incomplete surgical repair with subsequent persistence or recurrence of the prolapse. Despite their potential advantages in determining which organs are involved, however, available imaging procedures, i.e. contrast radiography, ultrasonography and, more recently, dynamic magnetic resonance imaging (MRI), still share some important limitations, such as lack of standardisation, validation and availability. In fact, existing methods of performing examinations and measurements of individual parameters vary greatly among researchers, making comparison of study results difficult. In addition, significant differences still exist in the definition and terminology of the most common pelvic descent processes as well as in the classification and quantification systems adopted.

Keywords

Pelvic Floor Anal Canal Rectal Prolapse Vaginal Vault Dynamic Magnetic Resonance Imaging 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRefGoogle Scholar
  2. 2.
    Ekberg O, Mahieu PHG, Bartram CI et al (1990) Defecography: dynamic radiological imaging in proctology. Gastroenterol Int 3:63–69Google Scholar
  3. 3.
    Kelvin FM, Maglinte DDT, Benson JT (1994) Evacuation proctography (defecography): an aid to the investigation of pelvic floor disorders. Obstet Gynecol 83:307–314PubMedGoogle Scholar
  4. 4.
    Hock D, Lombard R, Jehaes C et al (1993) Colpocystodefecography. Dis Colon Rectum 36:1015–1021PubMedCrossRefGoogle Scholar
  5. 5.
    Kelvin FM, Maglinte DDT, Benson JT et al (1994) Dynamic cystoproctography: a technique for assessing disorders of the pelvic floor in women. AJR Am J Roentgenol 163:368–370PubMedGoogle Scholar
  6. 6.
    Maglinte DDT, Kelvin FM, Hale DS et l (1997) Dynamic cystoproctography: a unifying diagnostic approach to pelvic floor and anorectal dysfunction. AJR Am J Roentgenol 169:759–767PubMedGoogle Scholar
  7. 7.
    Maglinte DDT, Kelvin FM, Fitzgerald DSH et al (1999) Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol 172:439–444PubMedGoogle Scholar
  8. 8.
    Brown MC, Sutherst JR, Murray A et al (1985) Potential use of ultrasound in place of X-ray fluoroscopy in urodynamics Br J Urol 57:88–90PubMedGoogle Scholar
  9. 9.
    Kohorn EI, Sciascia AL, Jeanty P et al (1986) Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence. Obstet Gynecol 68:269–272PubMedGoogle Scholar
  10. 10.
    Quinn MJ, Beynon J, McC. Mortensen NJ et al (1988) Transvaginal endosonography: a new method to study the anatomy of the lower urinary tract in urinary stress incontinence. Br J Urology 62:103–105Google Scholar
  11. 11.
    Kolbl H, Bernaschek G, Wolf G (1988) A comparative study of perineal scan and urethrocystography in patients with genuine stress incontinence. Arch Gynecol Obstet 244:39–45PubMedCrossRefGoogle Scholar
  12. 12.
    Schaer GN, Khoechli OR, Schuessler B et al (1995) Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 85:220–224PubMedCrossRefGoogle Scholar
  13. 13.
    Khullar V, Cardozo L, Salvatore S et al (1996) Ultrasound: a noninvasive screening test for detrusor instability. Br J Obstet Gynecol 103:904–908Google Scholar
  14. 14.
    Chang TS, Bohm-Velez M, Mendelson EB (1993) Nongynecological applications of transvaginal sonography AJR Am J Roentgenol 160:87–93Google Scholar
  15. 15.
    Rubens DJ, Strang JG, Bogineni-Misra S et al (1988) Transperineal sonography of the rectum: anatomy and pathology revealed by sonography compared with CT and MR imaging. AJR Am J Roentgenol 170:637–642Google Scholar
  16. 16.
    Sultan AH, Loder PB, Bartram CI et al (1994) Vaginal endosonography: new approach to image the undisturbed anal sphincter. Dis Colon Rectum 37:1296–1299PubMedCrossRefGoogle Scholar
  17. 17.
    Sandridge DA, Thorp JM (1995) Vaginal endosonography in the assessment of the anorectum. Obstet Gynecol 86:1007–1009PubMedCrossRefGoogle Scholar
  18. 18.
    Halligan S, Northover J, Bartram CI (1996) Vaginal endosonography to diagnose enterocele. Br J Radiol 69:996–999PubMedCrossRefGoogle Scholar
  19. 19.
    Peschers UM, DeLancey JO, Schaer GN et al (1997) Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol 104(9):999–1003PubMedGoogle Scholar
  20. 20.
    Alexander AA, Liu JB, Merton DA et al (1997) Fecal incontinence: transvaginal US evaluation of anatomic causes Radiology 199:529–532Google Scholar
  21. 21.
    Piloni V (2001) Dynamic imaging of pelvic floor with transperineal sonography. Tech Coloproctol 5:103–105PubMedCrossRefGoogle Scholar
  22. 22.
    Beer-Gabel M, Zbar AP (2002) Dynamic transperineal ultrasound in patients presenting with obstructed evacuation Tech Coloproctol 6:141CrossRefGoogle Scholar
  23. 23.
    Piloni V, Spazzafumo L (2005) Evacuation sonography. Tech Coloproctol 9:119–126PubMedCrossRefGoogle Scholar
  24. 24.
    Yang A, Mostwin JL, Rosenhein NB et al (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179:25–33PubMedGoogle Scholar
  25. 25.
    Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvicfloor descent. Eur Radiol 7(8):1309–1317PubMedCrossRefGoogle Scholar
  26. 26.
    Fielding JR, Griffiths DJ, Versi E et al (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171:1607–1610PubMedGoogle Scholar
  27. 27.
    Comiter CV, Vasavada SP, Barbaric ZL et al (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54(3):454–457PubMedCrossRefGoogle Scholar
  28. 28.
    Kelvin FM. Maglinte DDT, Hale DS et al (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88PubMedGoogle Scholar
  29. 29.
    DeLancey JOL, Hurd WW (1998) Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol 91:364–368PubMedCrossRefGoogle Scholar
  30. 30.
    Phillips SF, Edwards DAW (1965) Some aspects of anal continence and defaecation. Gut 6:396–406PubMedCrossRefGoogle Scholar
  31. 31.
    Healy JC, Halligan S, Reznek RH et al (1997) Patterns of prolapse in women with symptoms of pelvic floor weakness: assessment with MR imaging. Radiology 203:77–81PubMedGoogle Scholar
  32. 32.
    Pannu HK, Kaufman HS, Cundiff GW et al (2000) Dynamic MR imaging of pelvis organ prolapse: spectrum of abnormalities. Radiographics 20(6):1567–1582PubMedGoogle Scholar
  33. 33.
    Tunn R, DeLancey JOL, Quint EE (2001) Visibility of pelvic organ support system structures in magnetic resonance images without an endovaginal coil. Am J Obstet Gynecol 184:1156–1163PubMedCrossRefGoogle Scholar
  34. 34.
    Chou Q, DeLancey JOL (2001) A structured system to evaluate urethral support anatomy in magnetic resonance images. Am J Obstet Gynecol 185:44–50PubMedCrossRefGoogle Scholar
  35. 35.
    Tunn R, DeLancey JOL, Howard D et al (2003) Anatomic variation in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance. Am J Obstet Gynecol 188: 116–121PubMedCrossRefGoogle Scholar
  36. 36.
    DeLancey JOL (1999) Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol 180:815–823PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Vittorio Luigi Piloni
    • 1
  • Alberto Bazzocchi
    • 1
  • Rita Golfieri
    • 1
  1. 1.Department of Radiology, Pelvic Floor Imaging Centre, Radiologia GolfieriMalpighi-S-Orsola HospitalBolognaItaly

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