Practical Pelvic Floor Ultrasonography: A Multicompartmental Approach to 2D/3D/4D Ultrasonography of the Pelvic Floor

370 Pages·2017·35.69 MB·English

by  S. Abbas Shobeiri (eds.)

S. Abbas Shobeiri
Editor
Practical Pelvic Floor
Ultrasonography
A Multicompartmental
Approach to 2D/3D/4D
Ultrasonography of the
Pelvic Floor
Second Edition
123
Practical Pelvic Floor Ultrasonography
S. Abbas Shobeiri
Editor
Practical Pelvic Floor
Ultrasonography
A Multicompartmental Approach
to 2D/3D/4D Ultrasonography
of the Pelvic Floor
Second Edition
Editor
S. Abbas Shobeiri, MD, FACS, FACOG
Department of Obstetrics and Gynecology
Gynecologic Subspecialties, INOVA Women’s Hospital,
Virginia Commonwealth University
Falls Church, VA, USA
Department of Bioengineering
George Mason University
Fairfax, VA, USA
ISBN 978-3-319-52928-8 ISBN 978-3-319-52929-5 (eBook)
DOI 10.1007/978-3-319-52929-5
Library of Congress Control Number: 2017935976
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Late at nights, early in the mornings, and during the weekends,
I labored to rewrite and edit this book. It took about a year.
This came at the expense of precious time away from my wife
and my three daughters. I like nothing better than to be present
in their moments. They trusted that my self-imposed seclusion
was to disseminate knowledge, to learn, to teach, to investigate,
and to lessen women’s suffering.
Preface
In just a few years since the publication of the first edition of this book, mul-
ticompartmental pelvic floor ultrasonography has taken the leap to become
central to clinical investigation of pelvic floor disorders. The most promising
modality used to be magnetic resonance imaging, but MRI has had limita-
tions due to cost and access. Ultrasonography, on the other hand, is part of
general practice in obstetrics and gynecology, urology, physical therapy, and
colorectal surgery. Labial or perineal ultrasound imaging is widely available
to those who do not have endovaginal and endoanal ultrasound capability.
Endoanal imaging of the anorectal area has been the gold standard in anal
sphincter imaging for the past 20 years and has gained widespread popularity
[1–4]. 3D high-resolution endoluminal probes do not totally negate the need
for 2D perineal dynamic imaging. It is generally agreed that different ultra-
sound routes visualize different structures better, and because the pelvic floor
functions as a unit, a multicompartmental approach is advocated [3]. This
book addresses complimentary use of all three modalities of 2D perineal, 3D
endovaginal, and 3D endoanal ultrasonography.
The current book Practical Pelvic Floor Ultrasonography is the most up-
to-d ate, state-of-the-art practical review of current literature which provides
an introduction to pelvic floor imaging as well as a resource to be used during
initial and more advanced practice. The book stresses understanding of pelvic
floor anatomy [5, 6], as without a thorough understanding of the anatomy, the
sonographer will be at a loss what they are visualizing. Using meticulous
anatomical and histological studies, our group pioneered 3D endovaginal
imaging of the pelvic floor structures in 2006 and published the results in
early 2009 [7, 8]. We have collaborated with researchers across the world [3,
7] to refine the techniques. We have conducted workshops at the United States
and international conferences to disseminate our knowledge of comprehen-
sive pelvic floor ultrasonography to physicians, sonographers, and physical
therapists. We have collaborated with interested researchers, and as such,
since the publication of the first edition, there has been an explosion of
research utilizing comprehensive pelvic floor ultrasonography approach.
Endoluminal ultrasound techniques are less invasive than a pelvic exami-
nation and easily available for pelvic floor imaging. Development of 4D
imaging has increased perineal imaging competitiveness, but still endolumi-
nal imaging offers tremendous advantages. By the end of this book, we hope
the reader gains competence in performing perineal, endovaginal, and endo-
anal 2D/3D/4D ultrasound evaluation of the pelvic floor including anal
vii
viii Preface
sphincter and levator ani complex. After reading this book, the reader should
have a basic understanding of how to perform a perineal, an endovaginal, and
an endoanal pelvic floor ultrasound.
Dramatic improvement in 3D and 4D ultrasound imaging has allowed
greater insight into the complex anatomy of the pelvic floor and its pathologi-
cal modifications. Obstetric events leading to fecal and urinary incontinence
in women, the development of pelvic organ prolapse, and the mechanism of
voiding dysfunction and obstructed defecation can now be accurately
assessed, which is essential for appropriate treatment decision making.
Obstetrical events leading to pelvic floor disorders in females, the relation-
ship between periurethral structures, levator ani muscles, and anorectal sup-
port, and mechanisms of urinary incontinence, fecal incontinence, pelvic
organ prolapse, and obstructed defecation syndrome can now be easily evalu-
ated. Due to improvements in the diagnosis of these disorders, new forms of
treatments have been developed with better outcome for patients. New 3D/4D
perineal, 3D endoanal, and 3D endovaginal ultrasonographic techniques have
given better insight into the complex anatomy of the pelvic floor. Ultrasound
has replaced other modalities as the main imaging modality for the diagnosis
of pelvic floor disorders in women. 3D/4D perineal imaging, 3D endovaginal
imaging, and 3D endoanal imaging are each well established as individual
modalities for visualization of pelvic floor. Since pelvic floor structures func-
tion as a unit, there is consensus that 2D perineal imaging can give the most
valuable data for overall functional imaging of the pelvic floor, while 3D
endovaginal and 3D endoanal imaging can provide the most information on
the static structural integrity of the muscles. Information obtained from two
or more of these modalities can provide additive or complementary data.
Practical Pelvic Floor Ultrasonography provides an introduction to compre-
hensive pelvic floor ultrasonography as a cost-effective modality as well as a
resource to be used during more advanced practice.
In recognition of the pelvic floor disorders and their squeal on the quality
of life of women, the authors have compiled the practical evidence-based
book that will aid as a resource for practitioners with an interest in imaging,
diagnosis, and treatment of pelvic floor dysfunction. The book is meant to be
evidence-based and practical for the first-time users and confers technical
capability to the advanced readers. Concise textual information from
acknowledged experts is complemented by high-quality diagrams and images
to provide a thorough update of this rapidly evolving field. Measurement
protocols are introduced in the respective chapters and case reviews will be
demonstrated at the conclusion.
With luxurious number of well-marked pictures, new chapters on 3D peri-
neal ultrasonography, levator ani trauma, vaginal mesh, urethral bulking,
ultrasound in physiotherapy, operative ultrasonography, new technologies,
and finite element modelling written by experts in their fields, readers will
gain a clear understanding of the fundamental principles and techniques of
comprehensive pelvic floor ultrasonography as well as of the normal anatomy
Preface ix
of the pelvic floor and its modification in various benign pelvic floor disor-
ders. The book provides a rich practical resource, written in a way to satisfy
either a novice or an expert in the use of ultrasound in pelvic floor imaging.
Enjoy your reading.
Falls Church, VA, USA S. Abbas Shobeiri
References
1. Santoro G, Wieczorek A, Shobeiri S, Mueller E, Pilat J, Stankiewicz A, et al.
Interobserver and interdisciplinary reproducibility of 3D endovaginal ultrasound
assessment of pelvic floor anatomy. Int Urogynecol J. 2010;22(1):53–9.
2. Quiroz LH, Shobeiri SA, Nihira MA. Three-dimensional ultrasound imaging for diag-
nosis of urethrovaginal fistula. Int Urogynecol J. 2010;21(8):1031–3.
3. Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, et al. State
of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet
Gynecol. 2011;37(4):381–96.
4. Shobeiri SA, White D, Quiroz LH, Nihira MA. Anterior and posterior compartment 3D
endovaginal ultrasound anatomy based on direct histologic comparison. Int Urogynecol
J. 2012;23(8):1047–53.
5. Shobeiri SA, Chesson RR, Gasser RF. The internal innervation and morphology of the
human female levator ani muscle. Am J Obstet Gynecol. 2008;199(6):686. e1–e6.
6. Shobeiri SA, Elkins TE, Thomas KA. Comparison of sacrospinous ligament, sacrotu-
berous ligament, and 0 polypropylene suture tensile strength. J Pelvic Surg.
2000;6(5):261–7.
7. Santoro GA, Wieczorek AP, Stankiewicz A, Wozniak MM, Bogusiewicz M, Rechberger
T. High-resolution three-dimensional endovaginal ultrasonography in the assessment of
pelvic floor anatomy: a preliminary study. Int Urogynecol J Pelvic Floor Dysfunct.
2009;20(10):1213–22.
8. Shobeiri SA, Leclaire E, Nihira MA, Quiroz LH, O’Donoghue D. Appearance of the
levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography.
Obstet Gynecol. 2009;114(1):66–72.
Contents
1 Pelvic Floor Anatomy ................................................................... 1
S. Abbas Shobeiri
2 2D/3D Endovaginal and Endoanal Instrumentation
and Techniques .............................................................................. 23
S. Abbas Shobeiri
3 Instrumentation and Techniques for Perineal
and Introital Pelvic Floor Ultrasound ......................................... 49
Milena M. Weinstein, Kim W.M. Van Delft,
and S. Abbas Shobeiri
4 Perineal Pelvic Floor Ultrasound: Applications
and Literature Review .................................................................. 79
Alexandros Derpapas and Vik Khullar
5 3D Endovaginal Ultrasound Imaging of the Levator
Ani Muscles .................................................................................... 101
Lieschen H. Quiroz and S. Abbas Shobeiri
6 3D Endovaginal Ultrasound Imaging of Pelvic
Floor Trauma................................................................................. 121
Kim W.M. Van Delft, Ghazaleh Rostaminia,
and S. Abbas Shobeiri
7 Endovaginal Urethra and Bladder Imaging ............................... 143
Andrzej Paweł Wieczorek and Magdalena Maria Woźniak
8 2D/3D Transperineal and 3D Endovaginal Imaging
of the Posterior Compartment ..................................................... 171
Andrea C. Santiago and S. Abbas Shobeiri
9 Endovaginal Imaging: Vaginal Mesh and Implants .................. 193
Jittima Manonai, Pouya Javadian, and S. Abbas Shobeiri
10 Endovaginal Imaging: Slings ....................................................... 209
Aparna Hegde, S. Abbas Shobeiri, and G. Willy Davila
11 Imaging of Urethral Bulking Agents ........................................... 229
Aparna Hegde, G. Willy Davila, and S. Abbas Shobeiri
xi
xii Contents
12 Endovaginal Imaging: Pelvic Floor Cysts and Masses .............. 243
Ghazaleh Rostaminia and S. Abbas Shobeiri
13 Endoanal Ultrasonographic Imaging
of the Anorectal Region ................................................................ 253
Giulio Aniello Santoro and Sthela M. Murad-Regadas
14 Endoanal Imaging of Anorectal Cysts and Masses .................... 277
Sthela M. Murad-Regadas and Giulio Aniello Santoro
15 Ultrasound-Augmented Clinical Examination
and Intraoperative Pelvic Floor Ultrasonography ..................... 291
S. Abbas Shobeiri
16 Ultrasound in Pelvic Floor Physiotherapy .................................. 305
S. Abbas Shobeiri and Baerbel Junginger
17 Emerging Imaging Technologies and Techniques ...................... 327
Kang Kim, Vladimir Egorov, and S. Abbas Shobeiri
18 Patient-Specific Studies of Pelvic Floor Biomechanics
Using Imaging................................................................................ 337
Qi Wei, Siddhartha Sikdar, Parag Chitnis,
Ghazaleh Rostaminia, and S. Abbas Shobeiri
19 Pelvic Floor Ultrasonography: Post-Test Questions .................. 345
S. Abbas Shobeiri
Index ....................................................................................................... 363