A large cystocele may impair evaluation of urethral hypermobility, and TPUS can ensure empty bladder and/or manual replacement of a cystocele at the point of care. Studies comparing US to CCP have shown variable degrees of agreement for different measures of POP, including anorectal angle measurement, cystocele, rectocele, enterocele, descending perineum syndrome, and rectal prolapse [51-53], without emergence of a clear reference standard. For optimal multicompartment evaluation, CCP is performed with filling of the bladder, rectum, large and small bowel, whereas TPUS is generally performed without intraluminal contrast, although US gel can be instilled intravaginally or rectal as indicated. Appropriately performed TPUS with dynamic maneuvers can identify cul-de-sac herniation, although the exact contents may be more challenging to define than on MRI or CCP. Studies have shown significant correlation between TPUS and physical examination, for measures of prolapse, particularly in the anterior compartment [54,55], although US only predicted 59.6%, 61.5%, and 32.6% of prolapse cases in the anterior, posterior, and middle compartments, respectively, in one of these studies [55]. Another study demonstrated that TPUS failed to demonstrate abnormality in up to one-third of clinical cases of rectoceles [56]. In general, the main advantage of TPUS is that it is a noninvasive and less expensive technique with dynamic real- time functional assessment of the multiple compartments. US Pelvis Transrectal To our knowledge, there is no relevant literature to support the use of transrectal US (TRUS) alone for functional assessment of a protruding or bulging anterior vaginal mass or clinically suspected POP, particularly in the anterior or middle compartments. TRUS can be used for anatomic assessment of anal sphincter tears or defects, which can be associated with pelvic floor weakness.
Pelvic Floor Dysfunction in Females. A large cystocele may impair evaluation of urethral hypermobility, and TPUS can ensure empty bladder and/or manual replacement of a cystocele at the point of care. Studies comparing US to CCP have shown variable degrees of agreement for different measures of POP, including anorectal angle measurement, cystocele, rectocele, enterocele, descending perineum syndrome, and rectal prolapse [51-53], without emergence of a clear reference standard. For optimal multicompartment evaluation, CCP is performed with filling of the bladder, rectum, large and small bowel, whereas TPUS is generally performed without intraluminal contrast, although US gel can be instilled intravaginally or rectal as indicated. Appropriately performed TPUS with dynamic maneuvers can identify cul-de-sac herniation, although the exact contents may be more challenging to define than on MRI or CCP. Studies have shown significant correlation between TPUS and physical examination, for measures of prolapse, particularly in the anterior compartment [54,55], although US only predicted 59.6%, 61.5%, and 32.6% of prolapse cases in the anterior, posterior, and middle compartments, respectively, in one of these studies [55]. Another study demonstrated that TPUS failed to demonstrate abnormality in up to one-third of clinical cases of rectoceles [56]. In general, the main advantage of TPUS is that it is a noninvasive and less expensive technique with dynamic real- time functional assessment of the multiple compartments. US Pelvis Transrectal To our knowledge, there is no relevant literature to support the use of transrectal US (TRUS) alone for functional assessment of a protruding or bulging anterior vaginal mass or clinically suspected POP, particularly in the anterior or middle compartments. TRUS can be used for anatomic assessment of anal sphincter tears or defects, which can be associated with pelvic floor weakness.