TPUS can assess for urethral and bladder-neck mobility and urethral funneling in real time during maximal strain or Valsalva [54,59,68]; however, in contrast to VCUG, TPUS does not assess the bladder or urethra during active voiding. In addition to bladder-neck mobility and postvoid residual, TPUS may have utility in predicting response to treatment in patients with SUI with urethral sling placement based on preoperative measurement of pubourethral Pelvic Floor Dysfunction in Females distance and angle [69]. Although not the initial imaging test of choice, it may be used for assessment of urinary dysfunction in the appropriate clinical setting. US Pelvis Transrectal A few studies have reported the use of TRUS for assessment of the bladder neck and urethra in patients with SUI; however, these studies are dated [70-73]. To our knowledge, there is no relevant literature comparing TRUS to TPUS or TVUS for evaluation of patients with urinary dysfunction and no recent literature to support its use for evaluation of female patients with urinary dysfunction. US Pelvis Transvaginal To our knowledge, there is no relevant literature regarding the use of TVUS for functional evaluation of patients with urinary dysfunction; however, TVUS can be used to assess for anatomic abnormalities (other than a cystocele) causing a bulge in the anterior vaginal wall, such as a urethral diverticulum, vaginal wall cyst, or mass [67]. It can also be used to assess postvoid residual bladder volume and bladder wall thickness. Bladder wall thickness on TVUS has been shown to correlate with results of urodynamic testing in patients with voiding dysfunction [74]. TVUS can evaluate the morphology and volume of the circular urethral rhabdosphincter muscle; muscle volume has been associated with urethral closure pressures and SUI [66].
Pelvic Floor Dysfunction in Females. TPUS can assess for urethral and bladder-neck mobility and urethral funneling in real time during maximal strain or Valsalva [54,59,68]; however, in contrast to VCUG, TPUS does not assess the bladder or urethra during active voiding. In addition to bladder-neck mobility and postvoid residual, TPUS may have utility in predicting response to treatment in patients with SUI with urethral sling placement based on preoperative measurement of pubourethral Pelvic Floor Dysfunction in Females distance and angle [69]. Although not the initial imaging test of choice, it may be used for assessment of urinary dysfunction in the appropriate clinical setting. US Pelvis Transrectal A few studies have reported the use of TRUS for assessment of the bladder neck and urethra in patients with SUI; however, these studies are dated [70-73]. To our knowledge, there is no relevant literature comparing TRUS to TPUS or TVUS for evaluation of patients with urinary dysfunction and no recent literature to support its use for evaluation of female patients with urinary dysfunction. US Pelvis Transvaginal To our knowledge, there is no relevant literature regarding the use of TVUS for functional evaluation of patients with urinary dysfunction; however, TVUS can be used to assess for anatomic abnormalities (other than a cystocele) causing a bulge in the anterior vaginal wall, such as a urethral diverticulum, vaginal wall cyst, or mass [67]. It can also be used to assess postvoid residual bladder volume and bladder wall thickness. Bladder wall thickness on TVUS has been shown to correlate with results of urodynamic testing in patients with voiding dysfunction [74]. TVUS can evaluate the morphology and volume of the circular urethral rhabdosphincter muscle; muscle volume has been associated with urethral closure pressures and SUI [66].