Imaging may be obtained as an adjunct to clinical evaluation when needed to depict these abnormalities. Although multiple imaging examinations may be needed depending of specific patient scenarios, this variant focuses on the initial imaging test that should be obtained when deemed necessary in patients with urinary dysfunction. CT Pelvis To our knowledge, there is no relevant literature regarding the use of CT, either with or without IV contrast for functional assessment of urinary dysfunction. CT can depict anatomic abnormalities such as bladder masses, bladder wall thickening, large urethral diverticula, or urethral masses that may be associated with urinary dysfunction. CT may demonstrate signs of urinary tract infection. CT with IV contrast is generally preferred over CT without IV contrast for anatomic evaluation unless evaluating for small urinary calculi. Fluoroscopy Cystocolpoproctography Dynamic CCP involves fluoroscopic imaging during defecation with the patient sitting upright on a fluoroscopic commode. Images are obtained during rest, Kegel (contraction of the pelvic floor muscles), strain, and defecation. A dedicated cystographic phase with bladder opacification can be performed either prior to instillation of rectal contrast or after complete rectal emptying, in order to avoid underestimation of bladder prolapse due to mass effect from a distended rectum [22]. Although cystocele and bladder-neck mobility may be directly visualized when intravesical contrast is used or may be inferred from posterior displacement of vaginal contrast, the urethra is not typically visible on this examination [22]. When contrast is administered in the bladder, stress incontinence may be visualized during straining or defecation; however, to our knowledge, there is no relevant literature regarding the utility of fluoroscopic CCP specifically for assessment of urinary dysfunction.
Pelvic Floor Dysfunction in Females. Imaging may be obtained as an adjunct to clinical evaluation when needed to depict these abnormalities. Although multiple imaging examinations may be needed depending of specific patient scenarios, this variant focuses on the initial imaging test that should be obtained when deemed necessary in patients with urinary dysfunction. CT Pelvis To our knowledge, there is no relevant literature regarding the use of CT, either with or without IV contrast for functional assessment of urinary dysfunction. CT can depict anatomic abnormalities such as bladder masses, bladder wall thickening, large urethral diverticula, or urethral masses that may be associated with urinary dysfunction. CT may demonstrate signs of urinary tract infection. CT with IV contrast is generally preferred over CT without IV contrast for anatomic evaluation unless evaluating for small urinary calculi. Fluoroscopy Cystocolpoproctography Dynamic CCP involves fluoroscopic imaging during defecation with the patient sitting upright on a fluoroscopic commode. Images are obtained during rest, Kegel (contraction of the pelvic floor muscles), strain, and defecation. A dedicated cystographic phase with bladder opacification can be performed either prior to instillation of rectal contrast or after complete rectal emptying, in order to avoid underestimation of bladder prolapse due to mass effect from a distended rectum [22]. Although cystocele and bladder-neck mobility may be directly visualized when intravesical contrast is used or may be inferred from posterior displacement of vaginal contrast, the urethra is not typically visible on this examination [22]. When contrast is administered in the bladder, stress incontinence may be visualized during straining or defecation; however, to our knowledge, there is no relevant literature regarding the utility of fluoroscopic CCP specifically for assessment of urinary dysfunction.