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Techniques in Coloproctology
Erschienen in: Techniques in Coloproctology 5/2014

01.05.2014 | How I Do It

Translabial ultrasound in the assessment of pelvic floor and anorectal function in women with defecatory disorders

verfasst von: H. P. Dietz

Erschienen in: Techniques in Coloproctology | Ausgabe 5/2014

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Abstract

This article shows how modern ultrasound imaging can contribute to the investigation of patients with posterior vaginal wall prolapse, obstructed defecation, fecal incontinence and rectal intussusception/prolapse, conditions that should be similarly relevant and of interest to colorectal surgeons, gastroenterologists and gynecologists. Translabial/perineal ultrasound, a simple, universally available technique, may serve as a first-line diagnostic tool in women with posterior compartment prolapse and/or symptoms of obstructed defecation, largely replacing defecation proctography and magnetic resonance proctography. This has advantages for healthcare systems, since sonographic imaging is less expensive, non-invasive, less time-consuming and does not involve radiation exposure. However, there is a substantial need for teaching that remains unmet to date. This article illustrates in details the technique of translabial ultrasonography adopted by our unit and reviews the literature supporting this method of assessing pelvic floor and anorectal function in women with defecatory disorders.
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Literatur
1.
2.
Dietz HP, Korda A (2005) Which bowel symptoms are most strongly associated with a true rectocele? Aust N Z J Obstet Gynaecol 45:505–508PubMedCrossRef
3.
Davis K, Kumar D (2006) Posterior pelvic floor compartment disorders. Best Pract Res Clin Obstet Gynaecol 19:941–958CrossRef
4.
Kepenecki I, Kesinkilic B, Akinsu F et al (2011) Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity. Dis Colon Rectum 54:85–94CrossRef
5.
Dietz H (2004) Ultrasound imaging of the pelvic floor: part 1: 2D aspects. Ultrasound Obstet Gynecol 23:80–92PubMedCrossRef
6.
Kohorn EI, Scioscia AL, Jeanty P, Hobbins JC (1986) Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence. Obstet Gynecol 68:269–272PubMed
7.
Grischke EM, Dietz HP, Jeanty P, Schmidt W (1986) A new study method: the perineal scan in obstetrics and gynecology. Ultraschall Med 7:154–161PubMedCrossRef
8.
Dietz H (2004) Ultrasound imaging of the pelvic floor: 3D aspects. Ultrasound Obstet Gynecol 23:615–625PubMedCrossRef
9.
Bø K, Larson S, Oseid S, Kvarstein B, Hagen R, Jorgensen J (1988) Knowledge about and ability to do correct pelvic floor muscle exercises in women with urinary stress incontinence. Neurourol Urodyn 7:261–262
10.
Oerno A, Dietz H (2007) Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 30:346–350CrossRef
11.
Mulder F, Shek K, Dietz H (2012) The pressure factor in the assessment of pelvic organ mobility. Aust N Z J Obstet Gynaecol 52:282–285PubMedCrossRef
12.
Orejuela F, Shek K, Dietz H (2012) The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J 23:175–178PubMedCrossRef
13.
Dietz HP, Clarke B (2001) The influence of posture on perineal ultrasound imaging parameters. Int Urogynecol J 12:104–106CrossRef
14.
Jung S, Pretorius D, Padda B et al (2007) Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol 197:52.e1–52.e7CrossRef
15.
Dietz HP, Steensma AB (2005) Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Gynecol 26:73–77CrossRef
16.
Zhang X, Shek K, Dietz H (2013) How large does a rectocele have to be to cause symptoms? Int Urogynecol J 24:S61CrossRef
17.
Zbar A, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M (2003) Rectocele: pathogenesis and surgical management. Int J Colorectal Dis 18:369–384PubMedCrossRef
18.
Dietz H (2009) Rectocele or stool quality: what matters more for symptoms of obstructed defecation? Tech Coloproctol 13:265–268PubMedCrossRef
19.
Beer-Gabel M, Teshler M, Schechtman E, Zbar AP (2004) Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study. Int J Colorectal Dis 19:60–67PubMedCrossRef
20.
Beer-Gabel M, Teshler M, Barzilai N et al (2002) Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders: pilot study. Dis Colon Rectum 45:239–245PubMedCrossRef
21.
Zbar A, Beer-Gabel M (2007) Clinical dynamic transperineal ultrasonography in proctologic practice: the case for its use in patients presenting with evacuatory difficulty. In: Santoro GA, di Falco G (eds) Benign anorectal diseases: diagnosis with endoanal and endorectal ultrasound and new treatment options. Springer, Milan
22.
Perniola G, Shek K, Chong C, Chew S, Cartmill J, Dietz H (2008) Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol 31:567–571PubMedCrossRef
23.
Steensma AB, Oom DMJ, Burger C, Schouten W (2010) Assessment of posterior compartment prolapse: a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis 12:533–539PubMedCrossRef
24.
Dietz HP (2011) Can the rectovaginal septum be visualised on ultrasound? Ultrasound Obstet Gynecol 37:348–352PubMedCrossRef
25.
Richardson AC (1993) The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol 36:976–983PubMedCrossRef
26.
Guzman Rojas R, Shek K, Kamisan Atan I, Dietz H (2013) Defect-specific rectocele repair: medium-term subjective and objective outcomes. Neurourol Urodyn 32(6):868–870
27.
Beer-Gabel M, Assoulin Y, Amitai M, Bardan E (2008) A comparison of dynamic transperineal ultrasound (DTP-US) with dynamic evacuation proctography (DEP) in the diagnosis of cul de sac hernia (enterocele) in patients with evacuatory dysfunction. Int J Colorectal Dis 23:513–519PubMedCrossRef
28.
Morandi C, Martellucci J, Talento P, Carriero A (2010) Role of enterocele in the obstructed defecation syndrome (ODS): a new radiological point of view. Colorectal Dis 12:810–816PubMedCrossRef
29.
Fenner DE (1996) Diagnosis and assessment of sigmoidoceles. Am J Obstet Gynecol 175:1438–1442PubMedCrossRef
30.
Rodrigo N, Shek K, Dietz H (2011) Rectal intussusception is associated with abnormal levator structure and morphometry. Tech Coloproctol 15:39–43PubMedCrossRef
31.
Hwang JJ, Macinga D, Rorke EA (1996) Relaxin modulates human cervical stromal cell activity. J Clin Endocrinol Metab 81:3379–3384PubMed
32.
Konstantinovic ML, Steensma AB, Domali E et al (2007) Correlation between 3D/4D translabial ultrasound and colpocystodefecography in diagnosis of posterior compartment prolapse. Ultrasound Obstet Gynecol 30:448CrossRef
33.
Grasso R, Piciucchi S, Quattrocchi CC, Sammarra M, Ripetti V, Zobel BB (2007) Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography. Ultrasound Obstet Gynecol 30:86–94PubMedCrossRef
34.
Peschers UM, DeLancey JO, Schaer GN, Schuessler B (1997) Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. BJOG 104:999–1003CrossRef
35.
Kleinubing H Jr, Jannini JF, Malafaia O, Brenner S, Pinho TM (2000) Transperineal ultrasonography: new method to image the anorectal region. Dis Colon Rectum 43:1572–1574PubMedCrossRef
36.
Yagel S, Valsky DV (2006) Three-dimensional transperineal sonography for evaluation of the anal sphincter complex: another dimension in understanding peripartum sphincter trauma. Ultrasound Obstet Gynecol 27:119–123PubMedCrossRef
37.
Hall RJ, Rogers RG, Saiz L, Qualls C (2007) Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid- and distal levels. Int Urogynecol J 18:881–888CrossRef
38.
Lee J, Pretorius D, Weinstein MM, Guaderrama N, Nager CW, Mittal R (2007) Transperineal three-dimensional ultrasound in evaluating anal sphincter muscles. Ultrasound Obstet Gynecol 30:201–209PubMedCrossRef
39.
Cornelia L, Stephan B, Michel B, Antoine W, Felix K (2002) Trans-perineal versus endo-anal ultrasound in the detection of anal sphincter tears. Eur J Obstet Gynecol Reprod Biol 103:79–82PubMedCrossRef
40.
Shek K, Guzman Rojas R, Dietz HP (2013) Residual defects of the external anal sphincter are common after OASIS repair. Neurourol Urodyn 31:913–914
41.
Oom DM, West CR, Schouten WR, Steensma AB (2012) Detection of anal sphincter defects in female patients with fecal incontinence: a comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound. Dis Colon Rectum 55:646–652PubMedCrossRef
42.
Roos A, Abdool Z, Sultan A, Thakar R (2011) The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: the PREDICT study. Clin Radiol 66:597–604PubMedCrossRef
43.
Gainey HL (1943) Post-partum observation of pelvic tissue damage. Am J Obstet Gynecol 46:457–466
44.
Kearney R, Miller J, Ashton-Miller J, Delancey J (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 107:144–149PubMedCentralPubMedCrossRef
45.
Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113:225–230PubMedCrossRef
46.
Svabik K, Shek K, Dietz H (2009) How much does the levator hiatus have to stretch during childbirth? BJOG 116:1657–1662PubMedCrossRef
47.
Dietz H, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712PubMedCrossRef
48.
Dietz H, Gillespie A, Phadke P (2007) Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol 47:341–344PubMedCrossRef
49.
Valsky DV, Lipschuetz M, Bord A et al (2009) Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 201:91.e91–91.e97CrossRef
50.
Krofta L, Otcenasek M, Kasikova E, Feyereisl J (2009) Pubococcygeus-puborec talis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J 20:1175–1181CrossRef
51.
Cassado Garriga J, Pessarodona Isern A, Espuna Pons M, Duran Retamal M, Felgueroso Fabregas A, Rodriguez-Carballeira M (2011) Tridimensional sonographic anatomical changes on pelvic floor muscle according to the type of delivery. Int Urogynecol J 22:1011–1018PubMedCrossRef
52.
Albrich S, Laterza R, Skala C, Salvatore S, Koelbl H, Naumann G (2012) Impact of mode of delivery on levator morphology: a prospective observational study with 3D ultrasound early in the postpartum period. BJOG 119:51–60PubMedCrossRef
53.
54.
Alcalay M, Brecher S, Kalter A, Schiff E, Eisenberg V (2011) Different patterns of pelvic floor dysfunction in forceps and vacuum deliveries. Int Urogynecol J 22:S69–S70CrossRef
55.
Athanasiou S, Chaliha C, Toozs-Hobson P, Salvatore S, Khullar V, Cardozo L (2007) Direct imaging of the pelvic floor muscles using two-dimensional ultrasound: a comparison of women with urogenital prolapse versus controls. BJOG 114:882–888PubMedCrossRef
56.
Dietz HP, Shek KL (2009) Levator defects can be diagnosed by 2D translabial ultrasound. Int Urogynecol J 20:807–811CrossRef
57.
Dietz H (2007) Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 29:329–334PubMedCrossRef
58.
Dietz H, Bernardo M, Kirby A, Shek K (2010) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22:699–704PubMedCrossRef
59.
Kashihara H, Shek K, Dietz H (2012) Can we identify the limits of the puborectalis/pubovisceralis muscle on tomographic translabial ultrasound? Ultrasound Obstet Gynecol 40:219–222PubMedCrossRef
60.
Adisuroso T, Shek K, Dietz H (2012) Tomographic imaging of the pelvic floor in nulliparous women: limits of normality. Ultrasound Obstet Gynecol 39:698–703PubMedCrossRef
61.
Weemhoff M, Vergeldt T, Notten K, Serroyen J, Kampschoer P, Roumen F (2012) Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 23:65–71PubMedCentralPubMedCrossRef
62.
Zhuang R, Song Y, Chen Q et al (2011) Levator avulsion using a tomographic ultrasound and magnetic resonance–based model. Am J Obstet Gynecol 205:232.e231–232.e238CrossRef
63.
Abdool Z, Shek K, Dietz H (2009) The effect of levator avulsion on hiatal dimensions and function. Am J Obstet Gynecol 201:89.e81–89.e85CrossRef
64.
Dietz H, Bhalla R, Chantarasorn V, Shek K (2011) Avulsion of the puborectalis muscle causes asymmetry of the levator hiatus. Ultrasound Obstet Gynecol 37:723–726PubMedCrossRef
65.
Dietz H, Simpson J (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115:979–984PubMedCrossRef
66.
DeLancey JO, Morgan DM, Fenner DE et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302PubMedCrossRef
67.
Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J 19:633–636CrossRef
68.
Dietz HP, Chantarasorn V, Shek KL (2010) Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 36:76–80PubMedCrossRef
69.
Wong V, Shek K, Goh J, Rane A, Dietz HP (2011) Is levator avulsion a predictor for cystocele recurrence following anterior compartment mesh? Neurourol Urodyn 30:879–880
70.
Weemhoff M, Vergeldt T, Notten K, Serroyen J, Kampschoer P, Roumen F (2011) Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 23:65–71PubMedCentralPubMedCrossRef
71.
Model A, Shek KL, Dietz HP (2010) Levator defects are associated with prolapse after pelvic floor surgery. Eur J Obstet Gynecol Reprod Biol 153:220–223PubMedCrossRef
72.
Dietz HP, Hyland G, Hay-Smith J (2006) The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound. Neurourol Urodyn 25:424–427PubMedCrossRef
73.
Kearney R, Miller JM, Delancey JO (2006) Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 25:50–54PubMedCentralPubMedCrossRef
74.
Dietz H, Abbu A, Shek K (2008) The levator urethral gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol 32:941–945PubMedCrossRef
75.
Singh K, Jakab M, Reid W, Berger LA, Hoyte L (2003) Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse. Am J Obstet Gynecol 188:910–915PubMedCrossRef
76.
Dietz H, Bernardo M, Kirby A, Shek K (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22:699–704PubMedCrossRef
77.
Pilzek A, Shek K, Guzman Rojas R, Kamisan Atan I, Dietz H (2013) Recurrence after prolapse surgery: does partial avulsion matter? Neurourol Urodyn 32:708–710
78.
Dietz H, Shek K, Daly O, Korda A (2012) Can levator avulsion be repaired surgically? Int Urogynecol J 24:1011–1015PubMedCrossRef
79.
Weinstein MM, Pretorius D, Jung SY, Nager CW, Mittal R (2007) Anatomic defects in the puborectalis muscle in women with fecal incontinence. Ultrasound Obstet Gynecol 30:637CrossRef
80.
van de Geest L, Steensma AB (2010) Three-dimensional transperineal ultrasound imaging of anal sphincter injuries after surgical primary repair. Ultrasound Obstet Gynecol 36:270CrossRef
81.
Chantarasorn V, Shek K, Dietz H (2011) Sonographic detection of puborectalis muscle avulsion is not associated with anal incontinence. Aust N Z J Obstet Gynaecol 51:130–135PubMedCrossRef
82.
Steensma A, Konstantinovic ML, Burger C, De Ridder D, Timmermann D, Deprest J (2010) Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction. Int Urogynecol 21:861–867CrossRef
83.
Dietz H, Kirby A, Shek K, Bedwell P (2009) Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J 20:967–972CrossRef
84.
Shek K, Pirpiris A, Dietz H (2010) Does levator avulsion increase urethral mobility? Eur J Obstet Gynecol Reprod Biol 153:215–219PubMedCrossRef
85.
Dietz H, Shek K, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25:580–585PubMedCrossRef
86.
Dietz H, De Leon J, Shek K (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31:676–680PubMedCrossRef
87.
Yang J, Yang S, Huang W (2006) Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrsound Obstet Gynecol 26:710–716CrossRef
88.
Kruger J, Dietz H, Murphy B (2007) Pelvic floor function in elite nulliparous athletes and controls. J Ultrasound Med 30:81–85
89.
Hoff Braekken I, Majida M, Ellstrom Engh M, Dietz HP, Umek W, Bo K (2008) Test- retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function. Int Urogynecol J 19:227–235CrossRef
90.
Kruger J, Heap X, Murphy B, Dietz H (2008) Pelvic floor function in nulliparous women using 3-dimensional ultrasound and magnetic resonance imaging. Obstet Gynecol 111:631–638PubMedCrossRef
91.
Dietz H, Wong V, Shek KL (2011) A simplified method for determining hiatal biometry. Aust N Z J Obstet Gynaecol 51:540–543PubMedCrossRef
92.
Majida M, Braekken I, Bø K, Benth J, Engh M (2011) Anterior but not posterior compartment prolapse is associated with levator hiatus area: a three- and four-dimensional transperineal ultrasound study. BJOG 118:329–337PubMedCrossRef
93.
Barry C, Dietz H, Lim Y, Rane A (2006) A short-term independent audit of mesh repair for the treatment of rectocele in women, using 3-dimensional volume ultrasound: a pilot study. Aust N Z Cont J 12:94–99
94.
Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRef
95.
Gerges B, Kamisan Atan I, Shek KL, Dietz HP (2013) How to determine “ballooning” of the levator hiatus on clinical examination. Int Urogynecol J 24:1933–1937
96.
Dietz H, Korda A, Benness C, Wong V, Shek K, Daly O (2012) Surgical reduction of the levator hiatus. Neurourol Urodyn 31:872–873
97.
98.
Dietz HP (2010) The role of two- and three-dimensional dynamic ultrasonography in pelvic organ prolapse. J Minim Invasive Gynecol 17:282–294PubMedCrossRef
99.
Guzman Rojas R, Shek KL, Langer S, Dietz HP (2013) The prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol 42:461–466
Metadaten
Titel
Translabial ultrasound in the assessment of pelvic floor and anorectal function in women with defecatory disorders
verfasst von
H. P. Dietz
Publikationsdatum
01.05.2014
Verlag
Springer Milan
Erschienen in
Techniques in Coloproctology / Ausgabe 5/2014
Print ISSN: 1123-6337
Elektronische ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-013-1117-5

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