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

244 Pages·2014·13.777 MB·English

by  S. Abbas Shobeiri M.D. (auth.), S. Abbas Shobeiri (eds.)

S. Abbas Shobeiri
Editor
Practical Pelvic Floor
Ultrasonography
A Multicompartmental
Approach to 2D/3D/4D
Ultrasonography of
Pelvic Floor
123
Practical Pelvic Floor Ultrasonography

S. Abbas Shobeiri

Editor
Practical Pelvic Floor
Ultrasonography
A Multicompartmental Approach
to 2D/3D/4D Ultrasonography
of Pelvic Floor
Editor
S. Abbas Shobeiri, M.D.
Female Pelvic Medicine & Reconstructive Surgery
The University of Oklahoma Health Sciences Center
Oklahoma City , OK , USA
ISBN 978-1-4614-8425-7 ISBN 978-1-4614-8426-4 (eBook)
DOI 10.1007/978-1-4614-8426-4
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2013950169
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This book is dedicated to the four chambers of my heart:
Eileen, Sara, Sophie, and Susan who have been mentally,
spiritually, emotionally, and physically PRESENT in my life.

Pref ace
Imaging currently plays a limited role in the clinical investigation of pelvic
fl oor disorders. The most promising modality to date has been magnetic
resonance imaging. But MRI has limitations due to cost and access.
Ultrasonography, on the other hand, is part of general practice in obstetrics
and gynecology, urology, and colorectal surgery. Translabial or transperineal
ultrasound imaging was popularized by extensive publications by H.P. Dietz.
“The Atlas of Pelvic Floor Ultrasound” published in 2007 introduced trans-
perineal modality to a larger audience. Endoanal imaging of the anorectal
area has been the gold standard in colorectal surgery for the past 20 years.
“Benign Anorectal Diseases” by Giulio Santoro, M.D. in 2006 is perhaps
one of the better books on the subject of endoanal imaging. 3D Endovaginal
pelvic fl oor imaging is gaining in popularity [ 1–4 ]; however, it is limited by
the fact that true dynamic imaging is hindered by the presence of vaginal or
anal transducer. It is generally agreed that different ultrasound routes visual-
ize different structures better, but because the pelvic fl oor functions as a unit,
a multicompartmental approach may be preferred [3]. A book that has
addressed all three modalities has been “Pelvic Floor Disorders” by Giulio
Santoro, M.D. However, there is a need for a more focused book that purely
describes complimentary use of transperineal, endovaginal, and endoanal
ultrasound imaging.
The current book “Practical Pelvic Floor Ultrasonography” is the most
up-to- date, state-of-the-art review of current literature which provides an
introduction to pelvic fl oor imaging as well as a resource to be used during
initial and more advanced practice.
The book stresses understanding of pelvic fl oor anatomy [5, 6], as without
a thorough understanding of the anatomy, the sonographer will be at a loss
what they are visualizing. To assure that there is no doubt about the identity
of the structures visualized, our group pioneered 3D endovaginal imaging of
the pelvic fl oor structures in 2006 and published the results in early 2009 [7, 8].
We have collaborated with researchers across the world [3, 8] to refi ne the
techniques. We have conducted annual workshops at the International
Continence Society (ICS) and the International Urogynecological Association
(IUGA) to disseminate our knowledge of comprehensive pelvic fl oor ultraso-
nography to international physicians. We have coached interested researchers
and as such, currently, there is an explosion of manuscripts submitted utiliz-
ing comprehensive approach.
vii
viii Preface
Ultrasound techniques are minimally invasive and easily available for
pelvic fl oor imaging. Recent developments such as 3D/4D imaging have
increased their competitiveness. By the end of this book we hope the reader
gains competence in performing transperineal, endovaginal, and endoanal
3D/4D ultrasound evaluation of the pelvic fl oor including anal sphincter and
levator ani complex. After reading this book, the reader should have a basic
understanding of how to perform a transperineal, an endovaginal, and an
endoanal pelvic fl oor ultrasound.
Dramatic improvement in 3D and 4D ultrasound imaging has allowed
greater insight into the complex anatomy of the pelvic fl oor and its pathologi-
cal modifi cations. 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 fl oor 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
transperineal, 3D endoanal, and 3D endovaginal ultrasonographic and mag-
netic resonance imaging techniques have given better insight into the com-
plex anatomy of the pelvic fl oor. Ultrasound has replaced other modalities as
the main imaging modality for the diagnosis of pelvic fl oor disorders in
women. 3D/4D transperineal imaging, 3D endovaginal imaging, and 3D
endoanal imaging are each well established as individual modalities for visu-
alization of pelvic fl oor. Since pelvic fl oor structures function as a unit there
is consensus that 3D/4D transperineal imaging can give the most valuable
data for overall functional imaging of the pelvic fl oor 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 3D/4D compre-
hensive pelvic fl oor ultrasonography as a cost-effective modality as well as a
resource to be used during more advanced practice.
In recognition of the pelvic fl oor disorders and its 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 the imaging,
diagnosis, and treatment of pelvic fl oor dysfunction. The book is meant to be
concise, evidence-based, and practical for the fi rst-time users and confers
technical capability to the reader. Concise textual information from acknowl-
edged experts is complemented by high-quality diagrams and images to pro-
vide a thorough update of this rapidly evolving fi eld. Measurement protocols
are introduced in the respective chapters and case reviews will be demon-
strated at the conclusion.
With luxurious number of well-marked pictures, readers will gain a clear
understanding of the fundamental principles and techniques of 3D/4D com-
prehensive pelvic fl oor ultrasonography as well as of the normal anatomy of
Preface ix
the pelvic fl oor and its modifi cation in various benign pelvic fl oor disorders.
The book provides a rich practical resource, written in a simple step-by-step
approach for a novice in the use of ultrasound in pelvic fl oor imaging.
Oklahoma City , OK, USA S. Abbas Shobeiri, M.D.
References
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and interdisciplinary reproducibility of 3D endovaginal ultrasound assessment of pelvic
fl oor anatomy. Int Urogynecol J. 2010;22:53–9.
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