S. Abbas Shobeiri

Endovaginal Imaging: Vaginal Mesh and Implants

With rapid adoption of vaginal mesh kits into urogynecologic practice, the complications that followed were beyond the scope of practice for most practicing urogynecologists. The approach to management of implanted material has been made easy due to the fact that the polypropylene mesh is easily visualized with ultrasound, given its pathognomonic appearance. For those skilled in its use, ultrasound is an undeniable advantage. 3D endovaginal ultrasonography (EVUS) provides further benefit in its ability to access deep pelvic spaces that harbor mesh remnants.

2D/3D Transperineal and 3D Endovaginal Imaging of the Posterior Compartment

Ultrasound imaging has made it possible to clearly visualize the anatomy and to understand the functionality of the female pelvic floor. In this chapter, we will focus on the use of 2D/3D transperineal and 3D endovaginal ultrasound imaging in the assessment of the posterior compartment. Normal anatomy, ultrasound techniques, and equipment will be briefly reviewed. A detailed discussion of specific posterior compartment disorders, like rectocele, enterocele, intussusception, and pelvic floor dyssynergy, is included. Certain 3D endovaginal ultrasound findings that may help to explain the presence of obstructed defecation symptoms in a subset of patients with no gross abnormality on physical examination will also be discussed. The use of 3D endovaginal imaging to identify and characterize the presence of mesh in the posterior compartment will be covered as well.

Ultrasound in Pelvic Floor Physiotherapy

This chapter describes the use of pelvic floor ultrasound in physical therapy. As in urogynecology, ultrasound in physical therapy can be used for both clinical purposes and research. It provides an understanding of the different ways in which physicians and physiotherapists approach the scan and positioning of the patient during the scan. For the physiotherapist, the orientation of the image on the screen can be a powerful instrument for patient education and visual biofeedback. In physiotheraphy, ultrasound provides an excellent assessment of biomechanics behind the symptoms and the re-assessment of objective changes in mechanics that can be correlated with subjective outcomes. As a perfect tool for patient education and for visual biofeedback at every time during therapy, ultrasound can be used during the initial patient evaluation, during treatment, for re-assessment at the same treatment session, and for follow-up at a later date. The chapter provides ultrasound evaluation of different pelvic floor symptoms, as well as a quick overview of instrumentation and techniques, followed by principles of physiotherapy and its approach to patient evaluation and rehabilitation.

Instrumentation and Techniques for Perineal and Introital Pelvic Floor Ultrasound

This chapter describes instrumentation and techniques for pelvic floor ultrasound with introital and transperineal approaches. The reader will learn about the specific equipment, image orientation, and optimization, and details of 2D and 3D/4D imaging techniques. The chapter also describes different applications of the introital and transperineal imaging for evaluation of pelvic floor dysfunction, including pelvic floor biometry, pelvic floor hiatus and pelvic floor muscles evaluation, anal and urinary incontinence, and pelvic organ prolapse.

Ultrasound-Augmented Clinical Examination and Intraoperative Pelvic Floor Ultrasonography

The question that frequently arises is how can ultrasound change management in the operating room or in the office practice. This chapter showcases some advanced ultrasound techniques to augment physical examination, techniques that can be used intraoperatively for various conditions.

3D Endovaginal Ultrasound Imaging of Pelvic Floor Trauma

The complex levator ani anatomy is perhaps best visualized with three-dimensional endovaginal ultrasonography. In this chapter we will address the occurrence of levator ani muscle injury during childbirth, and investigate the role of pelvic ultrasound to identify and quantify the amount of birth-related levator ani muscle trauma.

Endovaginal Imaging: Slings

Multicompartment ultrasound imaging of the pelvis, including 3D endovaginal imaging and 2D dynamic assessment, is evolving into a useful tool in the assessment of post-implant behavior, including diagnosis and management of patients with complications related to synthetic tapes. It can help to understand the in vivo functional behavior of slings following surgery and to clarify the etiology of failure, including the reason for voiding dysfunction.

Patient-Specific Studies of Pelvic Floor Biomechanics Using Imaging

Biomechanical modeling and simulation of the pelvic floor structures have caught much attention in the past decade. Many computational approaches were developed with the goal of advancing our understanding the mechanism of the pelvic floor pathologies and improving treatment clinically. In this chapter, we review some of the existing work on building three dimensional (3D) models of the pelvic floor and modeling its mechanics.

Imaging of Urethral Bulking Agents

Urethral bulking is an office procedure for treatment of stress urinary incontinence that has increased in popularity in recent years. Numerous types of urethral bulking agents (UBAs) have been used since its first introduction in the 1930s.

3D Endovaginal Ultrasound Imaging of the Levator Ani Muscles

The complex levator ani anatomy is perhaps best visualized with three-dimensional endovaginal ultrasonography. In this chapter we will investigate imaging of different levator ani subdivisions and their relationship to the levator plate movement and function.