1Reserch Officer, Human Reproductive Research Centre, ICMR & Ex senior resident,
2Assistant Professor, Department of Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi
3Senior Resident, Department of Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi
4Associate Professor, Consultant, Department of Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi
5Senior Specialist, Department of Radio-diagnosis, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi
6Professor, Ex Head, Department Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi
Despite the common occurrence of posterior compartment prolapse (PCP), the anatomical defects causing it are not well understood. Unlike the anterior and middle compartment, the diagnosis and treatment of PCP can be challenging.
To evaluate the role of 2D transperineal sonography as a diagnostic tool for preoperative evaluation of women with posterior compartment prolapse.
A prospective comparative study was conducted over a period of one year, in the department of Obstetrics and Gynecology in collaboration with department of Radio-diagnosis, of a tertiary care hospital. A total of 31 symptomatic women with PCP and 30 age and parity matched asymptomatic controls were evaluated clinically and then examined by 2- D transperineal ultrasound using 5–12 MHz linear transducer. Sonographic quantification and identification of type of PCP was done in the supine position before and after voiding urine. The distance of most dependent part of bladder, cervix and rectal ampulla was noted from the line of reference (drawn from lower border of symphysis pubis), first at rest and then on maximal straining. Out of 31 women in study group 30 were taken up for site specific repair. Clinical and sonographic findings were correlated with defects detected at the time of surgery.
Sonographic diagnosis of posterior compartment defects showed a stronger correlation to surgical findings (p<0.000) than clinical findings. Transperineal ultrasound was found to be much more accurate than clinical examination for the diagnosis of a rectocele and enterocele, but had lower specificity for the diagnosis of perineal hyper mobility.
Transperineal ultrasound can be used as a diagnostic tool to differentiate different types of posterior compartment prolapse so as to individualise treatment.
Posterior compartment Prolapse, transperineal ultrasound, Rectocele, enterocele, perineal hypermobility
