Perineal video-ultrasonography in the assessment of vaginal prolapse: early observations.

Abstract

To investigate the efficacy of perineal ultrasonography in the assessment of vaginal prolapse. A prospective descriptive study. Urodynamic Unit, St. George's Hospital, London. Six women, three of them were awaiting colposuspension and three had had a colposuspension. Perineal ultrasound scans were performed on women with and without incontinence and prolapse, both before and after continence surgery. Movement of the bladder, urethra, uterus, vaginal vault and enterocele were observed during coughing and the valsalva manoeuvre. To assess reproducibility, six patients had six different measurements taken of bladder neck and prolapse position and movement relative to the symphysis. The measurements were plotted upon an X-Y co-ordinate axis. Each measurement was repeated three times and one way analysis of variance performed upon the readings. Perineal ultrasonography clearly demonstrated movement of the whole pelvic floor. Minor degrees of both anterior and posterior vaginal wall prolapse could be seen and quantified. An increase in posterior vaginal wall mobility was noted in women after colposuspension. All measurements taken were found to be reproducible. Perineal ultrasonography is easy to perform and is reproducible. It may improve understanding of why some women develop posterior vaginal wall prolapse after colposuspension and, conversely, why some women develop incontinence following anterior repair for prolapse.