title: [Imaging of pelvic organ prolapse].
abstract: Colpocystodefecography (CCD) and dynamic MRI with defecography (MRId) allow an alternation between filling and emptying the hollow organs and the maximum abdominal strain offered by the defecation. When applied in imaging these two principles reveal the masked or underestimated prolapses at the time of the physical examination. A rigorous application of the technique guarantees almost equivalent results from the two examinations. The CCD provides voiding views and improved analysis of the anorectal pathology (intussusception, anismus) but involves radiation and a more invasive examination. MRId has the advantage of providing continuous visibility of the peritoneal compartment, and a multiplanar representation, enabling an examination of the morphology of the pelvic organs and of the supporting structures, with the disadvantage of still necessitating a supine examination, resulting sometimes in an incomplete or impossible evacuation. The normal and abnormal results (cystoptosis, vaginal vault prolapse, enterocele, anorectal intussuception, rectocele, descending perineum, urinary and fecal incontinence) and the respective advantages and limits of the various imaging methods are detailed. Dynamic perineal and introital ultrasound remains more limited in the appreciation of posterior colpoceles and especially in anorectal disorders, than CCD or MRId. Endoanal ultrasound is the first line morphological evaluation of the anal sphincter. Transvaginal and introital ultrasound can detect some complications of suburethral tapes and meshes. Morphological and dynamic imaging are essential complementary tools to the physical examination, especially when a precise anatomic assessment is required to understand the functional complaint or when a reintervention is needed.
authors.affiliation: Centre de Radiologie, 151, av. de Saxe, 69003 Lyon, France. lapray@wanadoo.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Lapray
mesh_terms: D003127:Colposcopy / Q000379:methods*; D019841:Defecography / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D017773:Pelvic Floor / Q000473:pathology; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*