Finally, anatomic evaluation of the peripheral nerves with MR neurography may play a role in assessment of chronic or recurrent pain in patients after surgery. Although there are no studies evaluating the utility of gadolinium IV contrast after surgical repair in the pelvic floor, certain complications such as collections or fistula may be better depicted after contrast as is the case in other parts of the body. Thus, MRI of the pelvis with gadolinium IV contrast is a preferred examination for depiction of the majority of subacute or chronic complications after surgical repair of pelvic floor. US Pelvis Transabdominal Postoperative complications such as urinary retention and acute retropubic hematomas can be assessed with US; however, to our knowledge, there is no relevant literature regarding the use of TAUS for subacute or chronic complications of pelvic floor surgical repair. US Pelvis Transperineal TPUS 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 regard to anatomic evaluation, TPUS can detect levator muscle avulsion both before and after surgical repair for POP [47]. TPUS can visualize urethral bulking agents, urethral slings, and vaginal mesh [107]. TPUS is more sensitive for locating mesh and sling material compared with physical examination and urethrocystoscopy [112]. TPUS with tomographic reconstructions has been used to assess the location of midurethral slings after surgery [113]. Anterior and posterior components of sacrocolpopexy vaginal mesh can be seen with TPUS; however, evaluation of apical and cranial components of the sacrocolpopexy mesh is limited on TPUS [114]. TPUS is not able to visualize retropubic components of urethral slings or extrapelvic components of slings or mesh that traverse the obturator foramen or ischiorectal fossa.
Pelvic Floor Dysfunction in Females. Finally, anatomic evaluation of the peripheral nerves with MR neurography may play a role in assessment of chronic or recurrent pain in patients after surgery. Although there are no studies evaluating the utility of gadolinium IV contrast after surgical repair in the pelvic floor, certain complications such as collections or fistula may be better depicted after contrast as is the case in other parts of the body. Thus, MRI of the pelvis with gadolinium IV contrast is a preferred examination for depiction of the majority of subacute or chronic complications after surgical repair of pelvic floor. US Pelvis Transabdominal Postoperative complications such as urinary retention and acute retropubic hematomas can be assessed with US; however, to our knowledge, there is no relevant literature regarding the use of TAUS for subacute or chronic complications of pelvic floor surgical repair. US Pelvis Transperineal TPUS 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 regard to anatomic evaluation, TPUS can detect levator muscle avulsion both before and after surgical repair for POP [47]. TPUS can visualize urethral bulking agents, urethral slings, and vaginal mesh [107]. TPUS is more sensitive for locating mesh and sling material compared with physical examination and urethrocystoscopy [112]. TPUS with tomographic reconstructions has been used to assess the location of midurethral slings after surgery [113]. Anterior and posterior components of sacrocolpopexy vaginal mesh can be seen with TPUS; however, evaluation of apical and cranial components of the sacrocolpopexy mesh is limited on TPUS [114]. TPUS is not able to visualize retropubic components of urethral slings or extrapelvic components of slings or mesh that traverse the obturator foramen or ischiorectal fossa.