Transperineal ultrasonography

Abstract

Transperineal ultrasonography is an imaging technique that is not often used; however, in the specialty of coloproctology, it has its place. In this age of economic health reforms, this test, which is relatively cheap and accessible, is very useful in identifying and assessing rectoceles, intussusceptions, evacuatory apparatus lesions, and perineal muscle movement. Lesions and asynchronous movement of these muscles can lead to evacuatory dysfunction, particularly chronic constipation. One can assess this disorder quickly and accurately with transperineal ultrasound and prescribe the appropriate biofeedback or physiotherapy as necessary. The most cost-effective and practical use is in the prediction of sphincter repair outcome as a treatment of fecal incontinence. We have been able to demonstrate that this prediction is possible when displacement of the puborectal sling is measured. The degree of displacement can infer neurological integrity to the puborectalis and/or sphincter muscles. The measurement of this displacement correlates accurately with postoperative sphincter repair outcome. This allows the surgeon to give a prognosis to patients preoperatively, so that they can decide on the best treatment options and know what to expect. The reproducibility of the test is rather good, and the technical training period quite short. Transperineal ultrasonography is often readily available, as it requires no special ultrasound probe. It is easily performed with little inconvenience to the patient. It is not time consuming or painful, and thus is well tolerated by patients. It has the advantage of giving a dynamic visualization and assessment of the perineal muscles, while being a very cost-effective investigation when compared with magnetic resonance imaging or other imaging techniques © 2010 Springer-Verlag Milan.