Dynamic US of the pelvic floor enables direct visualization of the pelvic floor organs and is most commonly performed without installation of contrast. MRI with Endorectal/Endoanal Coil The use of endorectal coil may help better visualize the supporting ligaments in the pelvis, and assessment of baseline external anal sphincter thickness on endoanal MRI in patients with fecal incontinence can help predict outcomes after sphincter repair [16]; however, endoanal MRI is relatively invasive and may decrease patient acceptance and compliance. The coil can cause distortion of the pelvic tissues in patients who have a small pelvis. During functional assessment, the coil in the rectum may temporarily prevent prolapse [17]. For these reasons, endoanal MRI is not routinely performed at most centers, and the high-resolution images achievable with external phased-array coils are utilized. Echodefecography Echodefecography, a US technique performed with an endorectal probe and gel in the rectum, has been described for evaluation of posterior compartment dysfunction [18,19]. Echodefecography is not routinely available at most centers and thus is not discussed as a separate procedure in these guidelines. OR Discussion of Procedures by Variant Variant 1: Vaginal protrusion or bulge, or clinically suspected pelvic organ prolapse. Initial imaging. POP is the excessive descent of organs through the pelvic floor hiatus and typically involves protrusion of anterior or posterior vaginal walls and/or descent of the vaginal apex [20]. Patients usually present with pelvic pressure or bulge and often have other associated pelvic floor dysfunction. POP may involve various compartments of the pelvic floor, including the anterior (cystocele and/or urethrocele), apical (uterine/cervical and/or vaginal prolapse), and posterior (rectocele). In addition, pelvic contents at the posterior cul-de-sac may herniate into the rectovaginal space.
Pelvic Floor Dysfunction in Females. Dynamic US of the pelvic floor enables direct visualization of the pelvic floor organs and is most commonly performed without installation of contrast. MRI with Endorectal/Endoanal Coil The use of endorectal coil may help better visualize the supporting ligaments in the pelvis, and assessment of baseline external anal sphincter thickness on endoanal MRI in patients with fecal incontinence can help predict outcomes after sphincter repair [16]; however, endoanal MRI is relatively invasive and may decrease patient acceptance and compliance. The coil can cause distortion of the pelvic tissues in patients who have a small pelvis. During functional assessment, the coil in the rectum may temporarily prevent prolapse [17]. For these reasons, endoanal MRI is not routinely performed at most centers, and the high-resolution images achievable with external phased-array coils are utilized. Echodefecography Echodefecography, a US technique performed with an endorectal probe and gel in the rectum, has been described for evaluation of posterior compartment dysfunction [18,19]. Echodefecography is not routinely available at most centers and thus is not discussed as a separate procedure in these guidelines. OR Discussion of Procedures by Variant Variant 1: Vaginal protrusion or bulge, or clinically suspected pelvic organ prolapse. Initial imaging. POP is the excessive descent of organs through the pelvic floor hiatus and typically involves protrusion of anterior or posterior vaginal walls and/or descent of the vaginal apex [20]. Patients usually present with pelvic pressure or bulge and often have other associated pelvic floor dysfunction. POP may involve various compartments of the pelvic floor, including the anterior (cystocele and/or urethrocele), apical (uterine/cervical and/or vaginal prolapse), and posterior (rectocele). In addition, pelvic contents at the posterior cul-de-sac may herniate into the rectovaginal space.