Impact of Dynamic Transrectal Ultrasonography on Pelvic Organ Prolapse

Abstract

We developed a new method to evaluate pelvic organ prolapse dynamically in patients in supine and standing positions using transrectal ultrasonography. We visualized the descent and prolapse of pelvic organs in real time using dynamic transrectal ultrasonography. The dynamic transrectal ultrasonography findings were compared with intraoperative findings. A prospective analysis was performed including 31 women with symptomatic pelvic organ prolapse. Before surgical repair for pelvic organ prolapse, transrectal ultrasonography was performed by an operator separate from the surgeon, and the transrectal ultrasonography findings were compared with the intraoperative findings, focused on the diagnosis of pelvic organ prolapse. The patients were put on the fluoroscopic tilting table for passive postural change from supine to standing position. After injection of sonographic jelly into the vaginal lumen, the ultrasound probe was inserted into the rectum. With passive postural change from supine to standing position using the fluoroscopic tilting table, descent and prolapse of pelvic organs were dynamically evaluated in real time. Cystocele, uterine prolapse and rectocele were dynamically observed in this procedure. Morphological details of pelvic organ prolapse such as movement, sliding, eversion, descent, and looseness of vaginal wall and bladder wall were successfully demonstrated in most cases. Dynamic transrectal ultrasonography demonstrated a high sensitivity (85.0%), specificity (81.1%), and positive (77.3%) and negative (87.8%) predictive value. We successfully demonstrated morphological conditions and dynamic changes of pelvic organs during passive postural change using dynamic transrectal ultrasonography in real time. Dynamic transrectal ultrasonography can be a useful modality to visualize pelvic organ prolapse preoperatively.