Imaging of the Genitourinary Tract in Females

M. Louis Moy and Sandip P. Vasavada

Pelvic organ prolapse and pelvic floor relaxation are common problems in older multiparous women, affecting approximately 16% of women aged 40 to 56 years.1 A detailed knowledge of pelvic anatomy is paramount for the proper evaluation and management of such patients. Although a thorough pelvic examination is always indicated, even experienced clinicians may be misled by the physical findings, having difficulty differentiating among cystocele, enterocele, and high rectocele by physical examination alone. Depending on the position of the patient and strength of the Valsalva maneuver, the surgeon may be limited in his or her ability to accurately diagnose the components of pelvic prolapse. Furthermore, with uterine prolapse, the cervix and uterus may fill the entire introitus, making the diagnosis of concomitant anterior and posterior pelvic prolapse even more difficult. Regardless of the etiology of the support defect, the surgeon must identify all aspects of vaginal prolapse and pelvic floor relaxation for proper surgical planning. Accurate preoperative staging should reduce the risk of recurrent prolapse. Therefore, it must be understood that radiographic evaluation has an important role in the identification of these defects, and should be considered as an extension of the physical examination. One must realize that not all patients with complex pelvic floor pathology need imaging; however, it does enhance one's knowledge of the patient preoperatively, and accordingly finds its utility.

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