Vaginal and Transperineal Ultrasonography

Presented by Sultan et al.24 as an alternative imaging method for female patients, vaginal endosonography images the anal sphincters without distortion of the anal canal, submucosa, anal cushions, and sphincter muscles. The patients are placed in the left lateral position. A probe is inserted 3 cm into the vagina, using a transducer, covered by a water-filled balloon. A 7-MHz rotating endoprobe provides a 360-degree image in the same orientation as in anal ultrasonography. Comparisons between anal and vaginal ultrasonography of sphincter images in 20 patients demonstrated an underestimation of the sphincter thickness by the anal ultrasound. The authors concluded that the transanal hard probe resulted in luminal compression of the sphincter muscles. The significance of these observations is unknown.

Using conventional ultrasound equipment with a 5-MHz linear probe, images are obtained by positioning the probe on the midportion of the perineum, obtaining transverse images of the anal canal. The images obtained are comparable to those obtained from anal endosonography, with concentric muscular layers. Similar to transvaginal ultra-sonography, the anal canal is imaged undisturbed, and the IAS cushions are visible. Unlike transvaginal ultrasonogra-phy, transperineal ultrasonography can be performed on men and women. Conventional ultrasound equipment is available in most hospitals, and because no special probe is necessary, transperineal ultrasonography may become more widely accessible.

Beer-Gabel et al.25 have introduced dynamic transperineal ultrasound as a noninvasive method of assessing anatomy in patients with pelvic floor dysfunction. Defecog-raphy, the current method of dynamically evaluating the pelvic floor during evacuation, uses high levels of radiation and invasive injections of contrast dye into the anus and rectum. Transperineal ultrasound is noninvasive, and provides clear dynamic and still anatomical images of the pelvic floor, including the anal canal, the anal sphincters, the puborectalis sling, the urethra, and the bladder base. The anal sphincters can be seen in the transverse, sagittal, and longitudinal views, which may improve visualization of sphincteric defects or fistulous tracts.

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