Fluoroscopy Voiding Cystourethrography VCUG is a fluoroscopic technique that focuses on the bladder and urethra in the anterior compartment. Contrast is instilled into the bladder via a Foley catheter. Images are then taken in the upright position at rest and strain and during voiding. Cystocele is defined on VCUG as extension of the opacified urinary bladder below the level of the pubic symphysis and the urethral angle can be measured relative to the vertical axis of the patient [14]. VCUG can be used as an objective measure of change in cystocele height and urethral angle after surgical repair [14]. Wu et al [24] demonstrated a correlation between the shape of a cystocele seen on VCUG and outcomes after cystocele repair with anterior vaginal wall suspension procedure. A significant limitation of VCUG for assessment of POP is its focused evaluation that is limited to the anterior compartment (cystocele and urethral hypermobility). VCUG does not provide information regarding global function of the pelvic floor. Furthermore, a recent study showed lower prevalence and degree of cystoceles and urethral hypermobility on upright VCUG compared to supine MR defecography [25]. Because of its narrow focus on anterior compartment structures, utility of VCUG is limited to patients with suspected concomitant urinary dysfunction. Thus, it is rarely used for initial evaluation of patients with POP. To our knowledge, there is no relevant literature to support the use of VCUG for functional assessment of a protruding or bulging posterior vaginal mass or for clinically suspected POP in the middle or posterior compartment. MR Defecography MR defecography is one of the initial imaging tests of choice for evaluation of a vaginal protrusion or bulge, or clinically suspected POP. It allows for comprehensive anatomic and functional evaluation of the entire pelvic floor.
Pelvic Floor Dysfunction in Females. Fluoroscopy Voiding Cystourethrography VCUG is a fluoroscopic technique that focuses on the bladder and urethra in the anterior compartment. Contrast is instilled into the bladder via a Foley catheter. Images are then taken in the upright position at rest and strain and during voiding. Cystocele is defined on VCUG as extension of the opacified urinary bladder below the level of the pubic symphysis and the urethral angle can be measured relative to the vertical axis of the patient [14]. VCUG can be used as an objective measure of change in cystocele height and urethral angle after surgical repair [14]. Wu et al [24] demonstrated a correlation between the shape of a cystocele seen on VCUG and outcomes after cystocele repair with anterior vaginal wall suspension procedure. A significant limitation of VCUG for assessment of POP is its focused evaluation that is limited to the anterior compartment (cystocele and urethral hypermobility). VCUG does not provide information regarding global function of the pelvic floor. Furthermore, a recent study showed lower prevalence and degree of cystoceles and urethral hypermobility on upright VCUG compared to supine MR defecography [25]. Because of its narrow focus on anterior compartment structures, utility of VCUG is limited to patients with suspected concomitant urinary dysfunction. Thus, it is rarely used for initial evaluation of patients with POP. To our knowledge, there is no relevant literature to support the use of VCUG for functional assessment of a protruding or bulging posterior vaginal mass or for clinically suspected POP in the middle or posterior compartment. MR Defecography MR defecography is one of the initial imaging tests of choice for evaluation of a vaginal protrusion or bulge, or clinically suspected POP. It allows for comprehensive anatomic and functional evaluation of the entire pelvic floor.