| Popis: |
Dynamic transperineal ultrasonography (DTP-US) is a relatively simple technique that has only recently been exploited to assess the component parts of the anterior, middle, and posterior pelvic compartments and their interaction during provocative maneuvers such as straining and simulated defecation in patients presenting to gynecologists or coloproctologists with evacuatory dysfunction [1, 2]. This approach provides comparative images to those achieved with axial endoanal ultrasound (EAUS) transducers for the assessment of morphologic integrity of both the internal (IAS) and external (EAS) anal sphincters; [3] however, our group and others have defined a clinical role for DTP-US in dynamic mode during forcible straining as a principal adjunct to the clinical evaluation of patients presenting to specialized clinics with evacuatory difficulty and obstructed defecation [4, 5]. There is generally a poor correlation between the symptoms attributed to pelvic floor dysfunction and radiologically demonstrable findings [6], where most studies have shown that virtually all patients presenting with evacuatory difficulty have a multiplicity of pathologic problems ranging across each pelvic compartment [7]. Traditionally, evacuation proctography (or one of its extended techniques, including opacification of the small bowel, bladder, vagina, and even the peritoneal cavity), has been used to define the presence of major morphological anomalies – most notably, rectocele, enterocele, rectoanal intussusception, rectal prolapse, and descending perineum syndrome – which are then attributed by the clinician as relatively dominant pathologies implicated in the evacuatory symptomatology and then accordingly treated [8]. What is clear is that a multidisciplinary approach, involving gastroenterologists, surgeons, gynaecologists, urologists, and biofeedback technologists, is required for these patients with multicompartmental disease [9] and that even within defined disorders such as rectocele, the preoperative assessment using different modalities may subcategorize patients into groups with different management solutions [10]. This chapter defines the indications, experience, and pitfalls of DTP-US, describing the basic technique, advantages, and limitations in specific pelvic floor disorders and accuracy in those patients presenting to a pelvic floor dysfunction unit with primary disorders of rectal evacuation. |
