Routine T2-weighted images acquired at rest have utility in detecting and quantifying levator muscle defects in patients with prolapse with high interobserver reliability [38,39]. Muscle defects seen on MRI correlate with symptoms of POP or histories of prior vaginal reconstructive surgery or episiotomy [40]. Muscle thickness is measured reliably on MRI with external phased-array coils [41]. Secondary findings of vaginal support defects such as displaced lateral and apical vaginal wall are also seen on MRI [42,43]. US Pelvis Transabdominal To our knowledge, there is no relevant literature regarding the use of transabdominal US (TAUS) for assessment of a protruding or bulging vaginal mass or clinically suspected POP. US Pelvis Transperineal Transperineal US (TPUS) or translabial US can be used for anatomic and functional evaluation of the pelvic floor, including evaluation of a protruding or bulging vaginal mass or clinically suspected POP. Images are obtained via cine loops in multiple planes during rest, strain, and Kegel maneuvers, with both 2-D and 3-D imaging for anatomic and functional pelvic floor assessment. Patients may be positioned semi-upright or in the dorsal lithotomy position. With regards to anatomic evaluation, TPUS can detect levator muscle avulsion, a predictor of prolapse recurrence after surgical repair [47]. Patients with signs of POP tend to demonstrate a larger pelvic floor hiatal area [48]. Translabial US shows moderate-to-good agreement with MRI for detection of levator ani defects and moderate-to- very-good agreement with MRI for measurement of hiatal biometry [49]. With regards to functional evaluation, dynamic TPUS performed during maximal strain or Valsalva demonstrates bladder and cervical prolapse and can demonstrate rectocele, enterocele/sigmoidocele, and rectal intussusception in the posterior compartment [50]. Detailed evaluation of urethral dysfunction including descent, kinking, and funneling can be obtained during the evaluation.
Pelvic Floor Dysfunction in Females. Routine T2-weighted images acquired at rest have utility in detecting and quantifying levator muscle defects in patients with prolapse with high interobserver reliability [38,39]. Muscle defects seen on MRI correlate with symptoms of POP or histories of prior vaginal reconstructive surgery or episiotomy [40]. Muscle thickness is measured reliably on MRI with external phased-array coils [41]. Secondary findings of vaginal support defects such as displaced lateral and apical vaginal wall are also seen on MRI [42,43]. US Pelvis Transabdominal To our knowledge, there is no relevant literature regarding the use of transabdominal US (TAUS) for assessment of a protruding or bulging vaginal mass or clinically suspected POP. US Pelvis Transperineal Transperineal US (TPUS) or translabial US can be used for anatomic and functional evaluation of the pelvic floor, including evaluation of a protruding or bulging vaginal mass or clinically suspected POP. Images are obtained via cine loops in multiple planes during rest, strain, and Kegel maneuvers, with both 2-D and 3-D imaging for anatomic and functional pelvic floor assessment. Patients may be positioned semi-upright or in the dorsal lithotomy position. With regards to anatomic evaluation, TPUS can detect levator muscle avulsion, a predictor of prolapse recurrence after surgical repair [47]. Patients with signs of POP tend to demonstrate a larger pelvic floor hiatal area [48]. Translabial US shows moderate-to-good agreement with MRI for detection of levator ani defects and moderate-to- very-good agreement with MRI for measurement of hiatal biometry [49]. With regards to functional evaluation, dynamic TPUS performed during maximal strain or Valsalva demonstrates bladder and cervical prolapse and can demonstrate rectocele, enterocele/sigmoidocele, and rectal intussusception in the posterior compartment [50]. Detailed evaluation of urethral dysfunction including descent, kinking, and funneling can be obtained during the evaluation.