Perineal Ultrasonography Research Articles

The Effectiveness of Tamoxifen in the Prevention of Recurrent Urethral Strictures Following Internal Urethrotomy

Objective: Tamoxifen was not used earlier in clinical practice to decrease the urethral re-stricture rate after visual internal urethrotomy (VIU). In this study, we are the first to report the use of Tamoxifen as an adjuvant therapy to decrease the re-fibrosis and stricture recurrence post-VIU. Patients and Methods: Between 2015 and 2017, 60 patients underwent VIU for post-traumatic bulbar urethral stricture ≤1 cm. They were randomly divided into 2 groups (30 patients each). The Tamoxifen group cases received Tamoxifen 10 mg twice daily for 6 months post-VIU. The control group did not receive any medications. All patients were evaluated using the IPSS score, uroflowmetry, and perineal ultrasonography preoperatively at 3 and 6 months. Results: At presentation, there was no significant difference between patients of both groups in terms of IPSS score, Qmax, stricture width, and length. At 6 months follow-up, the mean IPSS score for the Tamoxifen group was 12.3 (8–19) in comparison with 20 (12–26) in the control group (p < 0.001). The Tamoxifen group had mean Qmax 11.1 mL/s (9–14), while those of the control group had mean Qmax 8.2 mL/s (6–10; p < 0.001). Using perineal ultrasound, only stricture width showed to be significantly smaller in the Tamoxifen group (p = 0.001). Conclusion: Tamoxifen seemed to be effective in reducing the recurrence of urethral stricture post-VIU. There was a significant improvement of the clinical outcome regarding Qmax and IPSS score after Tamoxifen adjuvant therapy.

Comparison of Urodynamics and Perineal Ultrasonography for the Diagnosis of Mixed Urinary Incontinence in Women

This study aimed to compare urodynamic studies (UDS) and perineal ultrasonography (US) for the assessment of mixed urinary incontinence (MUI) in women in China. Adult women with MUI and healthy control participants were enrolled from 2 centers in China (Zhejiang and Beijing) between September 2010 and April 2017. Baseline clinical characteristics were recorded. The MUI type was categorized by the King's Health Questionnaire: stress-predominant, urge-predominant, or equal predominance. Urodynamic studies were performed, followed within 1 week by perineal US. Tolerability of the investigations was compared by a 3-point scale: better than, worse than, or equal to. For UDS parameters, compared with controls, the urge-predominant MUI group had a lower maximal flow rate, smaller bladder volume, higher detrusor pressure at urethral opening, higher detrusor pressure at maximal flow, and higher incidence of detrusor overactivity; the stress-predominant MUI group had a lower maximal urethral closure pressure and functional urethral length; and the equal MUI group had a higher detrusor pressure at maximal flow and lower maximal urethral closure pressure (P < .05). For US parameters, compared with controls, the stress-predominant MUI group had a greater dynamic posterior urethral angle, dynamic angle of urethral inclination, descent of the bladder neck, and dynamic pubourethral distance; the urge-predominant MUI group had a greater detrusor thickness; and the equal MUI group had a greater descent of the bladder neck (P < .05). All UDS and US parameters differed significantly between the stress-predominant and urge-predominant groups (P < .05). The dynamic angle of urethral inclination, descent of the bladder neck, and dynamic pubourethral distance were inversely correlated with detrusor pressure at maximal flow and functional urethral length, while detrusor wall thickness was positively correlated with detrusor pressure at maximal flow and functional urethral length. Perineal US was better tolerated than UDS. Perineal US parameters show good correlations with UDS parameters. Ultrasonography is better tolerated than UDS and provides additional morphologic data. Perineal US could facilitate the diagnosis of urge-predominant MUI.

Perineal Ultrasound: a Review in the Context of Ejaculatory Dysfunction.

Ejaculation consists of the emission of semen from seminal vesicles and prostate, followed by expulsion. Ejaculatory dysfunction may take several forms including premature ejaculation, delayed or anejaculation, retrograde ejaculation, and painful ejaculation. Ejaculation is what we can see whereas orgasm is what we feel. The presence of ejaculate does not indicate the ability to experience orgasm. Hence, for the purpose of this work we consider orgasm and ejaculation as 2 separate neurobiological phenomena. To review the role of advanced investigative techniques such as perineal ultrasound in the diagnosis and management of ejaculation and ejaculatory dysfunction. We performed a PubMed search for key words individually and in combination: "ejaculation," "ejaculatory dysfunction," "delayed ejaculation," "painful ejaculation," "retrograde ejaculation," "perineal ultrasound," and "transrectal ultrasound." We also share our local experience using perineal ultrasound in assessing ejaculation. Perineal ultrasound can be used as an aid in the investigation of ejaculatory dysfunction. Evaluation of ejaculatory function hinges on a detailed psychosexual history and appropriate physical examination. Function of the ejaculatory center in the spine is androgen dependent; thus, hormonal evaluation is an important aspect of the workup. Disorders of ejaculation and orgasm require evaluation of neuromuscular reflexes activated during sexual activity. Dynamic ultrasonographic (US) ejaculatory-orgasmic studies allow for reproducible and detailed descriptions of the sexual response. Transrectal ejaculatory studies are useful in uncovering reasons for lack of antegrade semen emission, especially in men with poor sperm production or after vasectomy. Dynamic US studies contribute clinical utility in its non-invasive nature and can provide insight to the dynamic processes surrounding pelvic floor functioning in men. Perineal US for men with delayed ejaculation or anejaculation, painful ejaculation, or retrograde ejaculation may be helpful in select cases. Further research using this modality may help advance our understanding of ejaculatory dysfunction. Forbes CM, Flannigan R, Paduch DA. Perineal Ultrasound: a Review in the Context of Ejaculatory Dysfunction. Sex Med Rev 2018;6:419-428.

Ultrasonographic evaluation of pelvic floor function in elderly patients after total hysterectomy

Objective To evaluate the value of perineal pelvic ultrasonography in assessing the pelvic floor function of the elderly patients after total hysterectomy. Methods The clinical data of 56 cases of cervical cancer treated by hysterectomy in Zhejiang Taizhou Hospital from June 2014 to June 2017 were retrospectively analyzed.The results of perineal pelvic ultrasonography and various kinds of ultrasound examinations before and after surgery were analyzed. Results Among the 56 patients, 31 cases(55.4%)were diagnosed as pelvic floor dysfunction after hysterectomy.Post-operation group versus pre-operation group showed that posterior urethrovesical angle in resting state was〔(123.5±9.3)° vs.(90.4±8.6)°, P<0.05〕, posterior urethrovesical angle in the Valsalva movement was〔(135.7±13.5)° vs.(109.1±10.5)°, P<0.05〕, urethral rotation angle was〔(60.8±17.0)° vs.(27.0±12.1)°, P<0.05〕, bladder neck descent was〔(18.9±8.4)mm vs.(12.5±8.2)mm, P<0.05〕, bladder neck-symphyseal distance was〔(2.7±0.5)cm vs.(2.2±0.2)cm, P<0.05〕, with statistically significant differences in above parameters.Moreover, the statistically significant differences between post-operation group versus pre-operation group were found in detrusor wall thickness〔(4.4±0.8)mm vs.(3.8±0.6)mm, P<0.05〕, in the degree of bladder neck movement〔(0.6±0.1)cm vs.(0.4±0.2)cm, P<0.05〕, in the residual urinary volume〔(13.1±3.0)ml vs.(4.4±1.3)ml, P<0.05〕and in bladder rotation angle〔(12.0±2.7)°vs.(4.3±1.5)°, P<0.05〕. Conclusions The incidence of pelvic floor dysfunction is higher after hysterectomy in patients with cervical cancer, and pelvic floor function can be accurately evaluated by perineal pelvic ultrasonography, which is worthy of clinical reference. Key words: Uterine cervical neoplasms; Pelvic floor function; Hysterectomy

Can We Predict De Novo Urge Incontinence by Perineal Ultrasound?

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.

EP30.02: Transperineal 3D sonography: how to define a well positioned suburethral sling?

Numerous measures have been proposed with 3D sonography to describe perineum by transperineal route. Suburethral slings used for urinary stress incontinence are easily locatable with sonography and the aim of this study is to define a well-positioned suburethral sling on sagittal, axial and coronal view of the perineum and to explain which measures are useful to assess the good position of the sling. A prospective study with a preoperative and a postoperative systematic 3D transperineal sonography in case of surgical management of urinary stress incontinence by suburethral slings has been conducted. Women also had to fill out a questionnaire before and after surgery. Correlation between symptoms and position of the sling were evaluated and useful measures were defined. This prospective study is a monocentric one and an approval of the Ethics Committee has been obtained. Out of 20 women, we first describe normal urethra with perineal sonography. Urethra is often curvilinear with a mean length of 27.3mm. On sagittal view of the perineum, position of the sling has to be defined with the distance between vesical neck and the upper edge of the strip but also by the distance between externa urethral orifice and the lower edge of the strip. Both of these distances should be greater than 8mm. On axial view, the good spreading of the sling can be assess and finally, coronal view allows differentiation between retropubic and transobturator tape but also to check the symmetry of the sling. A distance of 3mm is often observed between posterior part of the urethra and the sling when women are very satisfied. A positive correlation was observed between symptoms and position of the sling, which allow the description of the good place for the sling. Sagittal, axial and coronal view of the perineum are useful to assess the good positioning of the sling.

Interobserver agreement in perineal ultrasound measurement of the anovaginal distance: a methodological study

Introduction and hypothesisObjective outcome measures of the extent of laceration at delivery are needed. In this study we evaluated and describe here a method for learning perineal ultrasound measurement of the anovaginal distance (AVD). The learning period needed for examiners proficient in vaginal ultrasound examination and the interobserver agreement after reaching proficiency in AVD measurement were determined. The hypothesis was that the method is feasible to learn and reproducible for use in further research.MethodsThe method was taught by an examiner experienced in perineal ultrasonography. The distance between the mucosal margin of the internal anal sphincter was measured with a vaginal probe. The studied examiners measured the AVD until similar results (±5 mm) were achieved. The AVD in 40 women was then measured and documented by two examiners who were blinded to each other’s results. Interobserver agreement was calculated using the kappa score.ResultsExaminers with previous experience in vaginal ultrasonography had learned the method after performing five sets of comeasurements. The AVD measurements after the learning period showed almost perfect agreement (κ = 0.87) between the examiners.ConclusionsThe method for perineal ultrasound measurement of AVD was learned quickly with high interobserver agreement. The method is feasible to learn and reproducible for use in further research.

Traditional Gymnastic Exercises for the Pelvic Floor Often Lead to Bladder Neck Descent - a Study Using Perineal Ultrasound.

The aims of physiotherapy in stress incontinent women are to improve pelvic floor function and the continence mechanism including bladder neck support and urethral closure pressure. In Germany, traditional conservative treatment often includes gymnastic exercises with unclear effects on the bladder neck. The aim of this study was to sonographically assess bladder neck movements during selected exercises. Fifteen healthy, continent women without previous vaginal births, who were able to voluntarily contract their pelvic floor muscels performed the shoulder bridge, the abdominal press, tiptoe and the Pilates clam exercises. The first set was performed without any additional instructions. During the second set directions were given to activate the pelvic floor before beginning each exercise and to maintain the contraction throughout the exercise. Bladder neck movement was measured on perineal ultrasound using a validated method with the pubic symphysis as a reference point. The median age of participants was 32 years, median BMI was 23. Eight women were nulliparous and seven had given birth to 1 - 2 children via caesarean section. When exercises were performed without voluntary pelvic floor contraction the bladder neck descended on average between 2.3 and 4.4 mm, and with pelvic floor contraction prior to the exercise only between 0.5 and 2.1 mm (p > 0.05 except for abdominal press p = 0.007). The Pilates clam exercise and toe stand stabilised the bladder neck most effectively. Bladder neck descent often occurs during pelvic floor gymnastic exercises as traditionally performed in Germany, and a voluntary pelvic floor contraction during the exercises does not necessarily prevent this.

173 Effect of Testosterone 2% Solution on Ejaculatory Function as Measured by Perineal Ultrasound in Hypogonadal Men

173 Effect of Testosterone 2% Solution on Ejaculatory Function as Measured by Perineal Ultrasound in Hypogonadal Men

Multi Detector Computed Tomography Fistulography In Patients of Fistula-in-Ano: An Imaging Collage.

SummaryFistula-in-ano, or perianal fistula, is a challenging clinical condition for both diagnosis and treatment. Imaging modalities such as fistulography, anal endosonography, perineal sonography, magnetic resonance imaging (MRI), and computed tomography (CT) are available for its evaluation. MRI is considered as the modality of choice for an accurate delineation of the tract in relation to the sphincter complex and for the detection of associated complications. However, its availability and affordability is always an issue. Moreover, the requirement to obtain multiple sequences to depict the fistula in detail is cumbersome and confusing for the clinicians to interpret. The inability to show the fistula in relation to normal anatomical structures in a single image is also a limitation.Multi detector computed tomography fistulography (MDCTF) is an underutilized technique for defining perianal fistulas. Acquisition of iso-volumetric data sets with instillation of contrast into the fistula delineates the tract and its components. Post-processing with thin sections allows for a generation of good quality images for presentation in various planes (multi-planar reconstructions) and formats (volume rendered technique, maximum intensity projection). MDCTF demonstrates the type of fistula, its extent, whether it is simple or complex, and shows the site of internal opening and associated complications; all in easy to understand images that can be used by the surgeons. Its capability to represent the entire pathology in relation to normal anatomical structures in few images is a definite advantage. MDCTF can be utilized when MRI is contraindicated or not feasible.This pictorial review shares our initial experience with MDCT fistulography in evaluating fistula-in-ano, demonstrates various components of fistulas, and discusses the types of fistulas according to the standard Parks classification.

Comparison of Invertography and Perineal Ultrasonography in the Initial Evaluation of Anorectal Malformations

Comparison of Invertography and Perineal Ultrasonography in the Initial Evaluation of Anorectal Malformations

Application of Acoustic Radiation Force Impulse Imaging for Diagnosis of Female Bladder Neck Obstruction.

To determine the application value of combined transperineal sonography and Virtual Touch tissue quantification (Siemens Medical Solutions, Mountain View, CA) on acoustic radiation force impulse imaging as a scanning method for diagnosis of female bladder neck obstruction. Transperineal sonography and Virtual Touch tissue quantification were combined to depict the bladder neck and observe its sonographic characteristics in 36 patients with female bladder neck obstruction and 30 healthy adults in a case-control study. We measured the thickness and shear wave velocity (SWV) of the bladder neck's anterior and posterior lips. There was a statistically significant difference in the thickness and SWV of the bladder neck between the healthy women and those with bladder neck obstruction, whose SWV was higher (P< .05). For the anterior lip, an SWV of 2.11 m/s was the best cutoff point for differentiating bladder neck obstruction from a normal bladder neck; for the posterior lip, an SWV of 2.06 m/s was the best cutoff point. The mean thicknesses of the anterior and posterior lips ± SD were 0.66 ± 0.05 and 0.68 ± 0.05 cm in the group with bladder neck obstruction versus 0.45 ± 0.07 and 0.52 ± 0.09 cm in the normal group. There was a significant difference between them (P < .05). The bladder neck's anatomic structure can be observed visually by perineal sonography. Virtual Touch tissue quantification on acoustic radiation force impulse imaging can quantitatively reflect the bladder neck stiffness and change in texture. It could provide a quantitative indicator for clinical diagnosis of female bladder neck obstruction and etiology research and display important clinical values.

Mean echogenicity and area of puborectalis muscle in women with stress urinary incontinence during pregnancy and after delivery.

Introduction and hypothesisPregnancy and childbirth are risk factors for the development of stress urinary incontinence (SUI). Urinary continence depends on normal urethral support, which is provided by normal levator ani muscle function. Our objective was to compare mean echogenicity and the area of the puborectalis muscle between women with and those without SUI during and after their first pregnancy.MethodsWe examined 280 nulliparous women at a gestational age of 12 weeks, 36 weeks, and 6 months after delivery. They filled out the validated Urogenital Distress Inventory and underwent perineal ultrasounds. SUI was considered present if the woman answered positively to the question “do you experience urine leakage related to physical activity, coughing, or sneezing?” Mean echogenicity of the puborectalis muscle (MEP) and puborectalis muscle area (PMA) were calculated. The MEP and PMA during pregnancy and after delivery in women with and without SUI were compared using independent Student’s t test.ResultsAfter delivery the MEP was higher in women with SUI if the pelvic floor was at rest or in contraction, with effect sizes of 0.30 and 0.31 respectively. No difference was found in the area of the puborectalis muscle between women with and those without SUI.ConclusionsWomen with SUI after delivery had a statistically significant higher mean echogenicity of the puborectalis muscle compared with non-SUI women when the pelvic floor was at rest and in contraction; the effect sizes were small. This higher MEP is indicative of a relatively higher intramuscular extracellular matrix component and could represent diminished contractile function.

Detection of Subpubic Tumor Causing Bladder Outlet Obstruction by 3D Perineal Ultrasound.

This case report shows that 3D perineal ultrasound can be superior to clinical examination and routine 2D perineal ultrasound in the detection of an unusual subpubic tumor. A 73-year-old female patient was referred to our urogynecological outpatient unit complaining of over-active bladder symptoms and voiding dysfunction for 3years. Gynecological examination found no signs of pelvic organ prolapse or abnormality in the vaginal cavity. Routine 2D perineal ultrasound showed substantial residual urine (ca. 300 ml on catheter) and limited bladder neck mobility, but no signs of pelvic organ prolapse. Use of standardized 3D perineal ultrasound revealed a 24 × 26 × 32 mm spherical, hypoechoic tumor below the pubic symphysis between the distal urethra and the pubic bones. This structure was mistaken for the pubic symphysis in the midline on 2D ultrasound performed earlier. At surgery, the tumor was completely excised through a vaginal incision between the urethra and the pubic symphysis. After an uneventful postoperative recovery the patient developed de-novo stress urinary incontinence, which was corrected successfully by the insertion of a retropubic tension-free suburethral sling after an interval of 8 weeks. After a further follow-up of 8 weeks the patient reported well-being, urinary continence and no voiding dysfunction; no abnormalities were found on examination. In conclusion, 3D perineal ultrasound is a useful additional tool for the diagnostic workup of bladder outlet obstruction.

Imaging for urinary incontinence

Ultrasonography and functional cine magnetic resonance imaging (MRI) are noninvasive and x-ray free tools, which are currently widely used in clinical diagnostics and scientific research of male and female urinary incontinence. The increasing use and improving techniques of modern imaging tools are closely linked to rapid development of minimally invasive surgery in patients with urinary incontinence and insights gained in continence mechanisms. Whereas ultrasonography is a cost-efficient and readily available diagnostic tool for a routine use, the more expensive functional MRI, as a tool with more precise visualization of functional interactions and spatial representation of anatomical structures of the pelvic floor, is suitable for complex diagnostic purposes and scientific research. Both tools are already well established for evaluations of the female pelvic floor. For evaluation of the male pelvic floor, and in particular postprostatectomy incontinence, perineal ultrasonography and functional cine MRI are becoming increasingly evident. Further development of both imaging tools will contribute to new insights into the continence mechanism and improve the techniques of radical prostatectomy and minimally invasive surgery of male and female urinary incontinence in the future.

MP51-13 BULBOCAVERNOSUS MUSCLE AREA AS A MARKER OF ANDROGENIZATION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation II1 Apr 2015MP51-13 BULBOCAVERNOSUS MUSCLE AREA AS A MARKER OF ANDROGENIZATION Nikhil Gupta, Amin Herati, Yuki Yamashita, and Bruce Gilbert Nikhil GuptaNikhil Gupta More articles by this author , Amin HeratiAmin Herati More articles by this author , Yuki YamashitaYuki Yamashita More articles by this author , and Bruce GilbertBruce Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1750AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment for hypogonadal symptoms is often essential to improve quality of life. However, traditional diagnostic tools, symptoms and serum testosterone level (T), often fail to identify men who would benefit from therapy. New markers may identify men of equivocal hypogonadal status who should receive T replacement. Studies have shown that the Bulbocavernosus Muscle (BCM) is androgen sensitive. Dabaja et al (Asian J Androl, 16:1-5, 2014) demonstrated that the BCM area is directly related to androgen receptor activity. Castration reduces the BCM area and androgen replacement increases BCM area in animal studies. This study investigates whether a relationship exists between BCM area serum testosterone and Luteinizing Hormone levels (LH) in a symptomatic male population. METHODS Men presenting with symptoms of hypogonadism underwent standard evaluation including a measurement of BCM area using B-mode perineal ultrasonography. Men with previous androgen treatment were excluded. Morning T (LH/MS) and LH levels were compared with BCM area to investigate a correlation between LH/testosterone and BCM area and BCM area normalized for body mass index (BMI). RESULTS Forty-three men presenting for erectile dysfunction, hypogonadism symptoms or infertility had both BCM area on ultrasound and morning T and LH levels. A correlation was found between T level and both BCM area and normalized BCM area with a T cutoff of 400 ng/dL. Below T of 400 ng/dL BCM area averaged 0.54 cm2, while above T of 400 ng/dL BCM area averaged 0.72 cm2. A correlation was also found between BCM area and LH level at a cutoff of 3 IU/L. Below LH 3 IU/L, BCM area averaged 0.71 cm2 and with LH above 3 IU/L BCM area averaged 0.56 cm2. No correlation was found between normalized BCM area and LH at this level. CONCLUSIONS Normal and low BCM area as measured by ultrasound correlate with T and LH levels. T < 400 ng/dl and LH > 3 IU/L correlate with decreased BCM area while T > 400 ng/dl and LH < 3 IU/L correlate with a normal BCM area. Thus BCM area appears to be a clinical marker of androgenization and can be useful, particularly in men with equivocal serum testosterone values, to identify those that might benefit from androgen supplementation. T < 400 T > 400 p LH < 3 LH > 3 p Age 54.3 54.1 0.98 49.7 55.0 0.34 BMI 29.6 25.8 0.03 26.4 29.6 0.10 BCM 0.54 0.72 0.02 0.71 0.56 0.03 Normalized BCM 0.02 0.03 0.01 0.02 0.02 0.13 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e624 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gupta More articles by this author Amin Herati More articles by this author Yuki Yamashita More articles by this author Bruce Gilbert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Müllerian cyst of the vagina masquerading as a cystocele.

Müllerian cysts are usually small, ranging from 0.1 to 2 cm in diameter. Rarely, they may be enlarged and mistaken for other structures, such as a cystocele or urethral diverticulum. We report on a female with symptomatic vaginal wall prolapse, diagnosed as a vaginal Müllerian cyst, which was originally misdiagnosed as a cystocele. The mass was soft and could be compressed manually without difficulty. Perineal ultrasonography and cystoscopy revealed no relationship between the cyst and the lower urinary tract, suggesting independence of the lesion. We performed surgical treatment with complete excision of the mass via a vaginal approach under spinal anaesthesia. The pathology result confirmed a benign Müllerian cyst lined with mucinous and squamous epithelium. When evaluating an anterior vaginal cyst, assessment of the lesion via history taking and pelvic examination is important to confirm both lesion size and location. Perineal ultrasonography performed with an empty bladder is useful to differentiate such vaginal cysts and to define their communication, if any, with adjacent organs.

Pelvic floor in females with anorectal malformations – findings on perineal ultrasonography and aspects of delivery mode

BackgroundAdvice on the mode of delivery to females born with anorectal malformation (ARM) is needed. The primary aim was to evaluate the anatomy of the pelvic floor muscles in females with ARM operated with posterior sagittal anorectal plasty (PSARP). The second aim was to correlate the extent of muscle defects to the bowel symptoms. MethodsThis interventional study with perineal 4D/3D ultrasonography describes the smooth muscles in the intestinal wall (neo-IAS), external sphincter, levators and anal canal using a muscle score (0–6 worst). The bowel symptoms were prospectively registered with Krickenbeck criteria score (0–7 worst). ResultsForty females with different subtypes of ARM, median age 13 (4–21), were followed up regarding bowel symptoms. Seventeen were examined with ultrasonography. Bowel symptoms were similar for those examined with ultrasonography and those not, median score 5 and 3 (1–7) respectively, (p=0.223, Fisher’s exact test). All the females had at least one muscular defect. There was no significant correlation between muscle defects and bowel symptoms (p=0.094, Spearman’s correlation). ConclusionFemales with ARM have considerable defects in the pelvic floor without any significant correlation to bowel symptoms. All women with ARM would benefit from individualized predelivery evaluations and caesarian section should be considered.

Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy.

Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

73 Two-dimensional perineal ultrasonography in men before and after radical prostatectomy

73 Two-dimensional perineal ultrasonography in men before and after radical prostatectomy