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Vaginal Surgery for Incontinence and Prolapse - part 3

Rectocele cũng được xem như là một lồi ra phía trước (đầu mũi tên) liên quan đến các ống hậu môn (dấu sao). (Từ Pannu HK MR động hình ảnh của phụ nữ sa cơ quan Radiol Clin Bắc Am 2003, 41 (2): 409 - 423 © năm 2003, với sự cho phép của Elsevier) | 50 Vaginal Surgery for Incontinence and Prolapse A B Figure 4.19. A The pubococcygeal line arrow used as a reference point radiographically is drawn from the inferior pubic symphysis to the sacrococcygeal junction. B Compared to the normal exam in A this image shows prolapse of the bladder b and vaginal vault long arrow below the pubococcygeal line compatible with a cystocele and vaginal vault prolapse. A rectocele is also seen as an anterior bulge arrowhead in relation to the anal canal asterisk . From Pannu HK. Dynamic MR imaging of female organ prolapse. Radiol Clin North Am 2003 41 2 409-423. 2003 with permission from Elsevier. Figure 4.20. A Typical H configuration of the vagina long arrows is seen in this MRI image. B A paravaginal detachment arrow . From Pannu HK. Dynamic MR imaging of female organ prolapse. Radiol Clin North Am 2003 41 2 409-423. 2003 with permission from Elsevier. Prolapse 51 A B Figure 4.21. Cystocele cervical prolapse with enterocele and perineal descent. A Normal resting image. B Compared to A this study was performed during defecation and shows a cystocele B a prolapsed cervix long arrow a widened rectovaginal space thick arrow and a low-lying rectum R . From Pannu HK. Dynamic MR imaging of female organ prolapse. Radiol Clin North Am 2003 41 2 409 423. 2003 with permission from Elsevier. Other Modalities Transperineal ultrasound has been described to assess dynamic function of the pelvic floor 81 . Dynamic anorectal endosonography has also been described and may detect the presence of enteroceles 82 . The role of these alternate modalities has not been fully elucidated and needs further study. Conclusion A thorough pelvic assessment is necessary prior to any planning regarding surgical or nonsurgi-cal intervention for pelvic organ prolapse. Patient history will direct the physician to look for appropriate findings on physical examination. The Pelvic Organ Prolapse Quantification system is gaining wider acceptance with physicians .