3D EUS Assessment of the Pelvic Floor - HD

3D Ultrasound Assessment of the Pelvic Floor

My name is Martin Koval.
I'm a colorectal surgeon on Mar Dam, vena PLAs
in Cologne, Germany.
And I'd like to tell you something about 3D ultrasound
of the pelvic floor.

Let's start now with our topic 3D
and ultrasound assessment of the pelvic floor.
There are some important questions.
Number one, how to perform 3D
and the ultrasound pelvic floor examination.
Is the patient positioned
during examination important or not?
What are the indications for pelvic floor sonography?
What is the advantage of the pelvic floor 3D ultrasound
and where can I learn all necessary scales?

Examination Arrangement and Position

This picture shows an arrangement
for a pelvic floor examination
and the most important thing you see on the left
side, that's a chair.
We start our examination in supine position,
then we request the patient to squeeze and press.
We are starting with transparent examination
then using all available probes.
As you see, this examination position is in not
physiological position, so
therefore we continue our examination using
our examination chair.
You seen before this physiological
position corresponds exactly to the position
during normal evacuation
as you can see on the small picture on the left side.

Importance of Examination Position

Why the examination position does matter,
is the gravity an important factor in it?
For that purpose, we examined four 80 female
with objectification syndrome
and compare discover disorders in supine versus
sitting examination position.
We presented our results on the annual meeting of
American Society of colorectal surgeons in 2014, Hollywood,
Florida, us.
And what you can see here is that
there is a big difference in findings
of pelvic floor disorders depending on examination position.
In other words, we will find much more pelvic floor
disorders in a physiological sitting position.
And this picture blue bars are supine position
as next we'll talk about indications
for the pelvic floor examination with sonography.

Indications for Pelvic Floor Sonography

Almost all pelvic floor disorders can reliable be seen
with 3D ultrasound.
Ultrasound permit us to detect rec cell and
or cell cysto cell ureter.
Cell changes in ethal, perfusion into deception, peral deens
or if implants, for example, tangible free ole tapes,
et cetera, accurately placed, even the function
of a implanted material can be verified easily.

On this image you see a normal transparent view
of a female pelvic floor
in a schematic view you see on the left side rectum,
then vagina and the bladder on the right side.

Let's come to this ORs on the pelvic floor, we could be seen
by ultrasound.
This image shows, rectal cell protruding into the inus
during vasalva obtained in a setting position.
We can observe in a schematic view
that normal evacuation cannot be performed.
Next image shows anor cell protruding between vagina
and anterior rectal wall in a schematic view, vagina,
bladder, anor cell,
and rectum compressed by anor cell.
This is a dynamic view
of a anterior cell compressing anterior rectal wall in high
resolution using see on the left side the
external sphincter muscle with an anterior part
of the rectum wall and on the right side just
protruding anterior cell.
Next image, trans panal view
of a cysto cell protruding during vasalva
and here has schematic view you see on the left side rectum,
then vagina and the cyst cell.
There is a quite big difference
to the normal trans peral view.

Next thing we can observe very good with our
pelvic sonography is a retrial perfusion.
This is a normal perfusion obtained in a young female.
Next thing is a pelvic floor.
The s you see on the left side, the rectum wall
and on the right side of the bladder.
In a schematic view, it become apparent
that all these organs are sinking.

And another domain for
pelvic floor sonography is the detection of interoception.
This here is a high resolution sonography
of the a**l cannel in the same patient.
On the left side you see a normal a**l canal
and on the right side, the inception,
That's the same patient in a motion picture.
And you see the interception coming from the
right side of the picture.
Here we got a example of one of our patient, young man
with abstraction by ification.
You see on the left side a normal a**l cannel in rest
and on the right side interception during the salva.
The interesting thing is the interception can only be found
in sitting position.
Here we can see the patient
before the procedure have been done.
And this is the same patient
after the resection of the interception.
As you can see, there is no mucosa prolapse anymore.

Advantages of 3D Pelvic Floor Ultrasound

So what is the advantage of our diagnostic tool?
It's easier and faster to perform than D therapy.
You don't need anyone else to do it.
Less incriminating for the patient could be stopped
and repeated at any time.
The patient understand what we are doing,
not only want pathological change,
but also combined changes could be detected.
All three compartments are examined at the same time.
Diagnostic quality is improving dramatically.
The changes could be showed
to your patient and it's cheaper.
Additionally, we can detect if the pelvic floor muscles are
intact, if the pelvic floor muscles can perform adequate
contraction, if this contraction is effective
or not, if rectal cell, cysto cell,
et cetera can be lifted by this contraction.
If any disc coordination of the pelvic floor can be observed
After pelvic fluor sonography, an individual therapy concept
for each patient could be found.

Learning Opportunities

All necessary techniques for 3D pelvic floor
and ultrasound could be learned in our simulation workshops,
which we also offer worldwide.
Thank you for your attention.