Ultrasonographic studies of the
lower urinary Tract, Anorectal
Tract and Pelvic Floor
p.bastani
Tabriz university of medical
science
Two and Three-dimensional ultrasound
imaging are gaining in popularity within the
clinical setting and are sometimes replaced
radiography in the evaluation of pelvic floor
disorders,because of:
·non invasiveness
·reproducibility
·nonradiation exposure
·and less expense
Many approaches have been proposed for
the evaluation of the lower urinary tract by
urltrasound. These include transabdominal,
transrectal, perineal (or translabial )and
introital approachs.
* The examination can be performed in dorsal
lithotomy.
Semi-recumbent or standing position.
* The image must be oriented in the sagittal
position to obtain accurate data from
symphsis pubis,urethra,bladder neck,
vagina, cervix,rectum and annual canal.
Ultrasonographic images of the
female lower urinary tract
Ultrasound assessment of the Anterior Zone
change in urethral diameter during straining may
be used to assess the integrity of the urethral
and bladder neck closure mechanisms.
Bladder base descent greater than 10 mm and
funnelling during straining might suggest a
pubourethral (pul) defect.
Repeating this manoeuvre after unilateral
anchoring at midurethra restores geometry and
continence (petros & von Konsky)
Ultrasound Assessment of the Middle Zone
Knowledge of the Middle zone and its relationship to
the anterior and Posterior zones can be obtained by
observing changes in morphology During straining,
coughing and after anchoring various connective
structures.
overactive bladder
recurrent urinary tract
diverticel
TVT-tape in the bladder 6 years after
surgery
Ultrasonography after surgery
After anterior and middle zones defect repair with
mesh, it can be accurately identified by Ultrasound
Ultrasound assessment of posterior zone
Pointing the probe more posteriorly, one can resualize
the anus, rectum, longitudinal muscle of the anus
(LMA) and levator plate (lp)
The benefits are:
* Endosonography allows visualization of defects in
the internal and external sphincters.
* Additionally the pictures obtained from
endosonography provide a road map for repair of
the sphincter.
Orientation of the probe in a female patient showing
the “U” sling of the puborectalis (PR) with vagina anterior
Complete division of the internal anal sphincter
with a defect (arrows) high in the canal at the level of the
puborectalis (PR)
benefits
Also with endosonography we can follow anal
fistula.
If an external opening can be identified, some doctors
will introduce hydrogen peroxide H2O2 (3-5%) in
to opening immediately before acquiring a 2D or
3D data set. The H2O2 enhances the fistula tracts
so that they appear bright with structures in the
ultrasound image.
Anorectal ultrasonography
*Endosonography is recognized as a valuable tool in
the assessment of Anorectal problems.
* An endoanal probe must permit a 360° image
mode and it must facilitate a high center
frequency.
* The probe head diameter should be relatirely small
and cylindrical for maneavering the transducer in
the anal canal.
At last:
Ultrasound is a relatively inexpensive office tool
which allows the clinician to determine the dynamic
geometry of pelvic organs at rest. During effort, to
identify the pelvic muscles, their movement relative
to rest, and the location of implanted tapes and
meshes.