The inherent high soft-tissue contrast resolution of MRI allows for anatomic evaluation of the pelvic organs, including the bladder and urethra, as well as urethral ligaments [37], and postoperative changes if present. MRI of the pelvis can demonstrate differences in pelvic floor musculature and bladder-neck morphology and urethrovesical angle when comparing patients with SUI, mixed UI, and continence [62]. MRI can also depict morphological alterations in the urethra, urethral ligaments, and vaginal fascia in patients with SUI [63-65]. Routine MRI of the pelvis with IV contrast may be preferred over MR defecography or MRI pelvis dynamic maneuvers without defecation for evaluation of pelvic floor anatomy and postoperative changes only, however, is not generally used for assessment of urinary dysfunction. US Pelvis Transabdominal To our knowledge there is no relevant literature regarding the use of TAUS for functional evaluation of the urethra or bladder neck in patients with urinary dysfunction. TAUS has utility for measurement of postvoid residual bladder volume and anatomic assessment of the bladder during evaluation of patients with urinary dysfunction. US Pelvis Transperineal TPUS can be used for anatomic and functional evaluation of the pelvic floor. 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. Postvoid residual bladder volume can be measured, and bladder wall thickening or trabeculation can be seen. TPUS can evaluate the morphology and volume of the circular urethral rhabdosphincter muscle; muscle volume has been associated with urethral closure pressures and SUI [66]. TPUS can also assess for anatomic abnormalities that can cause a bulge in the anterior vaginal wall, such as a urethral diverticulum, vaginal wall cyst, or mass [67].
Pelvic Floor Dysfunction in Females. The inherent high soft-tissue contrast resolution of MRI allows for anatomic evaluation of the pelvic organs, including the bladder and urethra, as well as urethral ligaments [37], and postoperative changes if present. MRI of the pelvis can demonstrate differences in pelvic floor musculature and bladder-neck morphology and urethrovesical angle when comparing patients with SUI, mixed UI, and continence [62]. MRI can also depict morphological alterations in the urethra, urethral ligaments, and vaginal fascia in patients with SUI [63-65]. Routine MRI of the pelvis with IV contrast may be preferred over MR defecography or MRI pelvis dynamic maneuvers without defecation for evaluation of pelvic floor anatomy and postoperative changes only, however, is not generally used for assessment of urinary dysfunction. US Pelvis Transabdominal To our knowledge there is no relevant literature regarding the use of TAUS for functional evaluation of the urethra or bladder neck in patients with urinary dysfunction. TAUS has utility for measurement of postvoid residual bladder volume and anatomic assessment of the bladder during evaluation of patients with urinary dysfunction. US Pelvis Transperineal TPUS can be used for anatomic and functional evaluation of the pelvic floor. 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. Postvoid residual bladder volume can be measured, and bladder wall thickening or trabeculation can be seen. TPUS can evaluate the morphology and volume of the circular urethral rhabdosphincter muscle; muscle volume has been associated with urethral closure pressures and SUI [66]. TPUS can also assess for anatomic abnormalities that can cause a bulge in the anterior vaginal wall, such as a urethral diverticulum, vaginal wall cyst, or mass [67].