Aleksandra Stankiewicz

High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study

Introduction and hypothesisOur aim was to evaluate the morphological characteristics of the female pelvic floor that may be further elucidated with three-dimensional endovaginal ultrasonography (3D-EVUS).MethodsA consecutive series of 20 nulliparous females underwent 3D-EVUS. Measurements were determined according to pre-established criteria. Descriptive statistics and Spearman’s correlation test were performed.ResultsThe levator hiatus (LH) was measured in the oblique plane parallel to the pubovisceral muscle. A positive correlation was found between LH area and age (p = 0.03). The anteroposterior diameter of the urogenital hiatus, measured in the axial plane tilted from the symphysis pubis to the ischiopubic rami, correlated with LH area (p = 0.008). No urethral rotations were observed in the coronal plane. Significant correlations were found among urethral parameters. Mean anal sphincter measurements were comparable to previously reported magnetic resonance imaging and ultrasound measurements.Conclusions3D-EVUS allows measurements of key pelvic floor structures in planes that cannot be determined by conventional imaging modalities.

Interobserver and interdisciplinary reproducibility of 3D endovaginal ultrasound assessment of pelvic floor anatomy

Introduction and hypothesisThe study aims were to evaluate (1) the interobserver and (2) the interdisciplinary repeatability of levator hiatus, urethral thickness, and anorectal angle measurements using three-dimensional endovaginal ultrasound (3D-EVUS).MethodsTwenty-seven nulliparous asymptomatic females were imaged with 3D-EVUS. Analyses were conducted off-line from stored 3D volumes by six readers (two radiologists, two urogynecologists, and two colorectal surgeons) using a standardized technique. Reproducibility was determined using the interclass correlation coefficients (ICC).ResultsThe overall interobserver repeatability for levator hiatus dimensions was good to excellent (ICC, 0.655–0.889), for urethral thickness was good (ICC, 0.624), and for anorectal angle was moderate (ICC, 0472). The interdisciplinary repeatability for levator hiatus indices was good to excellent (ICC, 0.639–0.915), for urethral thickness was moderate to good (ICC, 0.565–0.671), and for anorectal angle was fair to moderate (ICC, 0.204–0.434).Conclusions3D-EVUS yields reproducible measurements of levator hiatus dimensions and urethral thickness in asymptomatic nulliparous women.

3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability

OBJECTIVES Assessment of the urethral complex and defining its morphological characteristics with 3-dimensional endovaginal ultrasonography with the use of high frequency rotational 360° transducer. Defining inter-observer reliability of the performed measurements. MATERIALS AND METHODS Twenty-four asymptomatic, nulliparous females (aged 18-55, mean 32 years) underwent high-frequency (12MHz) endovaginal ultrasound with rotational 360° and automated 3D data acquisition (type 2050, B-K Medical, Herlev, Denmark). Measurements of the urethral thickness, width and length, bladder neck-symphysis distance, intramural part of the urethra as well as rhabdosphincter thickness, width and length were taken by three investigators. Descriptive statistics for continuous data was performed. The results were given as mean values with standard deviation. The relationships among different variables were assessed with ANOVA for repeated measures factors, as well as T-test for dependent samples. Intraclass correlation (ICC) was calculated for each parameter. Intra- and interobserver reliability was assessed. Statistical significance was assigned to a P value of <0.05 (two-tailed). RESULTS Excellent reliability was observed for urethral measurements (length, width, thickness and volume) (ICC>0.8) and good reliability for rhabdosphincter measurements (ICC>0.6) between all three investigators. CONCLUSIONS Advanced EVUS provides detailed information on anatomy and morphology of the female urethral complex. Our results show that 360° rotational transducer with automated 3D acquisition, currently routinely used for proctological scanning is suitable for the reliable assessment of the urethral complex and can be applied in a routine diagnostics of pelvic floor disturbances in females.

Uterus and ovary hernia of the canal of Nuck

Hernia of the canal of Nuck is a rare condition occurring in female infants. The canal of Nuck is a portion of the processus vaginalis of the peritoneum within the inguinal canal. The processus vaginalis is an evagination of parietal peritoneum of the embryonic lower anterior abdominal wall that passes into the inguinal canal. Normally, it loses its connection with the peritoneal cavity, but when it fails to close a hydrocele or hernia may result. We present a 2-month-old girl with a palpable movable mass in the right inguinal region. Ultrasonography revealed a hernia containing uterus and ovary. Ultrasonography is the examination of choice in female infants with a pathological mass in the groin. Its availability and accuracy facilitate diagnosis and proper surgical treatment.

Pelvic floor disorders: role of new ultrasonographic techniques

The paper presents the role of various ultrasound modalities in the diagnostics of female pelvic floor disorders (PFD). It describes the use of two/three/four-dimensional transperineal ultrasound and endocavitary transducers, which, up to now, have been used for proctological examinations and prostate cancer brachytherapy. Ultrasonography is the most widely available imaging modality. As a result of technical progress, novel transducers and more sophisticated software have recently been introduced to the market providing more information about the anatomy of pelvic organs. Some features of these transducers, such as higher frequency and multiplanar imaging, enable better visualisation of pelvic floor organs. In-depth knowledge of the technical and physical properties of modern ultrasonography, as well as its advantages and limitations, could provide an integrated approach to imaging of PFD. Technical modalities, the wide availability of ultrasonographic techniques, and an understanding of the imaging possible with modern ultrasonography could improve our understanding of PFD and allow better assessment in pre- and post-surgical management.

Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy

High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed evaluation of the pelvic floor muscles and the levator ani complex, the lower urinary tract, and the anorectal region in planes that cannot be determined by conventional two-dimensional EVUS. Multiplanar reconstruction and rendering techniques allow the investigator to correctly recognize and measure specific anatomic elements of the pelvic floor and to understand their true spatial relationships (anterior, lateral, and posterior compartments). This modality is relatively easy to perform and is time efficient, correlates well with other imaging modalities, and delivers relevant information in patients with pelvic floor disorders.

Technical Innovations in Pelvic Floor Ultrasonography

In this chapter the diagnostic potential of evaluating structural and functional interactions of female pelvic floor structures using novel image-processing techniques is presented. Technical innovations include three-dimensional volume render mode, maximum intensity projection, manual segmentation and sculpting, fusion imaging, PixelFlux, framing, color vector mapping, and motion tracking. When introduced into routine clinical practice, these new modalities will improve the management of pelvic floor dysfunctions.