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Three-Dimensional Transperineal Ultrasonography of the Pelvic Floor

Improving Visualization for New Clinical Applications and Better Functional Assessment

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Address correspondence to Simcha Yagel, MD, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, PO Box 24035, Mt Scopus, 91240 Jerusalem, Israel. E-mail: simcha.yagel{at}gmail.com

Objective. With increasing awareness of the scope of pelvic floor disorders has come development and introduction into clinical practice of new imaging techniques, with increasing importance of ultrasonography. Complex pelvic floor anatomy, the conceptual difficulty in the basics of some pelvic floor disorders, and the uneven standardization of ultrasonographic techniques were the impetuses of this review. The purpose of this study was to review the basic anatomy of the pelvic floor and the transperineal ultrasonographic evaluation technique and to provide an overview of the current clinical use of 3-dimensional transperineal ultrasonography in the evaluation of the anterior and posterior pelvic floor compartments. Methods. A literature review illustrated with index cases from our center was conducted. Results. Ultrasonography has been widely applied to evaluation of the anterior and posterior compartments of the pelvic floor. Three-dimensional ultrasonography has a role in improving pelvic floor assessment. Conclusions. Three-dimensional transperineal ultrasonography has been applied to evaluation of normal and pathologic pelvic floor anatomy. Practical application, through well-designed and sufficiently powered clinical studies, will establish the association between the clinical presentations of dysfunction with ultrasonographic findings.

Key Words: anal sphincter complex • pelvic floor imaging • tension-free vaginal tape • 3-dimensional transperineal ultrasonography • 3-dimensional ultrasonography

Abbreviations: ES, external sphincter • GSI, genuine stress incontinence • IS, internal sphincter • MPR, multiplanar projection • MRI, magnetic resonance imaging • PVM, pubovisceral muscle • 3D, 3-dimensional • 3DTUS, 3-dimensional transperineal ultrasonography • 3DUS, 3-dimensional ultrasonography • 2DUS, 2-dimensional ultrasonography • TVT, tension-free vaginal tape