Dynamic CCP involves fluoroscopic imaging during defecation with the patient sitting in physiologic upright position on a fluoroscopic commode. Images are obtained during rest, Kegel (contraction of the pelvic floor muscles), strain, and defecation. CCP demonstrates good agreement with surgical findings for detection of full-thickness rectal prolapse, posterior colpocele, rectocele, and peritoneocele and demonstrates excellent correlation for internal rectal prolapse (intrarectal and intra-anal). Sensitivities of CCP for detection of internal rectal prolapse and peritoneocele are 88% and 83%, respectively. [23]. There are few studies comparing CCP to surgical findings for assessment of anterior and middle compartment prolapse. The degree of concordance between CCP and physical examination varies based on the site of prolapse. Relative to physical examination, sensitivity of CCP for detection of cystoceles, rectoceles, and enteroceles is 96%, 94%, and 35%, respectively. Conversely, physical examination detects 83% of cystoceles, 77% of rectoceles, and 51% of enteroceles seen on CCP [11]. Thus, CCP may detect prolapse that is clinically occult. In general, the biggest advantage of CCP is that it allows for functional evaluation in the physiologic upright seated positioning. CCP also allows for assessment of barium contrast retention within rectoceles, which favors clinically relevant rather than incidental findings when present. Known limitations of fluoroscopic CCP include the lack of soft-tissue contrast resolution and the inability to directly visualize pelvic floor anatomy, particularly the pelvic floor muscles and fascia or postsurgical changes in the pelvic floor. As previously mentioned, dynamic CCP also requires installation of contrast in the bladder and vagina as well as administration of oral contrast prior to the examination in order to adequately assess all pelvic floor compartments.
Pelvic Floor Dysfunction in Females. Dynamic CCP involves fluoroscopic imaging during defecation with the patient sitting in physiologic upright position on a fluoroscopic commode. Images are obtained during rest, Kegel (contraction of the pelvic floor muscles), strain, and defecation. CCP demonstrates good agreement with surgical findings for detection of full-thickness rectal prolapse, posterior colpocele, rectocele, and peritoneocele and demonstrates excellent correlation for internal rectal prolapse (intrarectal and intra-anal). Sensitivities of CCP for detection of internal rectal prolapse and peritoneocele are 88% and 83%, respectively. [23]. There are few studies comparing CCP to surgical findings for assessment of anterior and middle compartment prolapse. The degree of concordance between CCP and physical examination varies based on the site of prolapse. Relative to physical examination, sensitivity of CCP for detection of cystoceles, rectoceles, and enteroceles is 96%, 94%, and 35%, respectively. Conversely, physical examination detects 83% of cystoceles, 77% of rectoceles, and 51% of enteroceles seen on CCP [11]. Thus, CCP may detect prolapse that is clinically occult. In general, the biggest advantage of CCP is that it allows for functional evaluation in the physiologic upright seated positioning. CCP also allows for assessment of barium contrast retention within rectoceles, which favors clinically relevant rather than incidental findings when present. Known limitations of fluoroscopic CCP include the lack of soft-tissue contrast resolution and the inability to directly visualize pelvic floor anatomy, particularly the pelvic floor muscles and fascia or postsurgical changes in the pelvic floor. As previously mentioned, dynamic CCP also requires installation of contrast in the bladder and vagina as well as administration of oral contrast prior to the examination in order to adequately assess all pelvic floor compartments.