Ultasound in Coloproctologic Practice: Dynamic Transperineal Ultrasound and Transvaginal Sonography

Dynamic transperineal ultrasonography (DTP-US) is a recently developed and studied novel and simple means for the real-time assessment of component parts of the anterior, middle, and posterior pelvic compartments and their interaction during provocative maneuvers such as straining and simulated defecation. Although it potentially rivals axial endoanal ultrasonography in the quality and resolution of images that it provides statically for the assessment of the integrity of the internal and external anal sphincters, it also may be most useful in dynamic mode for the assessment of patients primarily presenting with evacuatory dysfunction or those with defecation difficulty following pelvic surgery. There is generally a poor correlation between the symptoms attributed to pelvic floor dysfunction and radiologically demonstrated anatomical findings (1), and studies have shown that the vast majority of patients presenting with evacuatory disorders have a multiplicity of pathology (2). The traditional assessment of these patients often involves a fairly poorly tolerated “extended” defecographic technique requiring opacification of the small bowel, bladder, vagina, and even the peritoneal cavity to determine pathology of the pelvic floor compartments (3) with a presumptive decision-making process to define what represents the dominant pathology in such patients (4). Recently, static DTP-US has been used to assess the morphology and integrity of the anal sphincter components in nullipara (particularly where expensive endoluminal probes are not available), producing images that are as accurate as axial endoanal ultrasonography (5,6). Dynamic real-time TP-US is a new noninvasive technique simply performed (and learned) that assesses the anterior, middle, and posterior per