The dynamic ultrasound In pelvic floor – a replacement for defecography ? Martin Kowallik MAGEN DARM ZENTRUM WIENER PLATZ 1

The failure of the ligamnets and muscular structures provides a sinking and prolapse of pelvic organs into the vagina

The number of concerned persons is huge ! The question if the treatment of this patient is conservative or operative does not matter ! An established diagnosis should be done before we decide about the treatment ! MAGEN DARM ZENTRUM WIENER PLATZ 3

Which diagnostic tool have been used untill now ? MAGEN DARM ZENTRUM WIENER PLATZ 4

Defecography (classic) Which pelvic floor disorders could be seen withn this tool: rectocele enterocele intussusception Perineal descensus MAGEN DARM ZENTRUM WIENER PLATZ 5

Sending our patient to perform defecography Additional problem: Sending our patient to perform defecography We´re„giving“ this important diagnostic step out of our hands !!! -this could produce some qualtiative problems (faults) MAGEN DARM ZENTRUM WIENER PLATZ 6

Which is the right tool to avoid this ? MAGEN DARM ZENTRUM WIENER PLATZ 7

The dynamic 3D EUS permit us to detect: rectocele enterocele cystocele urethrocele changes in urethral perfusion intussusception perineal descensus if implants (TVT ect.) are correctly placed MAGEN DARM ZENTRUM WIENER PLATZ 8

The evidence for this MAGEN DARM ZENTRUM WIENER PLATZ 9

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enterocele in 3D Modus MAGEN DARM ZENTRUM WIENER PLATZ 11

rectocele MAGEN DARM ZENTRUM WIENER PLATZ

rectocele in 3D Modus MAGEN DARM ZENTRUM WIENER PLATZ 13

Intusussception MAGEN DARM ZENTRUM WIENER PLATZ 14

urethral perfusion MAGEN DARM ZENTRUM WIENER PLATZ 15

cysto- recto and enterocele with descensus MAGEN DARM ZENTRUM WIENER PLATZ 16

cystocele MAGEN DARM ZENTRUM WIENER PLATZ 17

urethrocele MAGEN DARM ZENTRUM WIENER PLATZ 18

Position of implanted material MAGEN DARM ZENTRUM WIENER PLATZ 19

Appereance of whole pelvic floor All compartments in 3D EUS MAGEN DARM ZENTRUM WIENER PLATZ 20

What is the advantage of this diagnostic tool ? MAGEN DARM ZENTRUM WIENER PLATZ 21

it is easier and faster to perform then defecography You do not need anyone else to do it Less incriminating for the patient Could be stopped and repeated at any time The patient understand what she/he see Not only one pathological change, but also combined changes could be detected MAGEN DARM ZENTRUM WIENER PLATZ 22

all three compartments are examined at the same time diagnostic quality is improving dramatically The changes could be showed to your patient it´s cheaper then defecography MAGEN DARM ZENTRUM WIENER PLATZ 23

upper bowel could be seen better in defecography disatvantages: training curve upper bowel could be seen better in defecography In that case we should use the defecography MAGEN DARM ZENTRUM WIENER PLATZ 24

In case of anamnestic affirmed outlet obstruction: pelvic floor EUS in case of outlet obstruction without sonographic findings defecography (classic) MAGEN DARM ZENTRUM WIENER PLATZ 25

Is the dynamic 3d ultrasound In pelvic floor – a real replacement for defecography ? MAGEN DARM ZENTRUM WIENER PLATZ 26

It´s a tool to detect almost all pelvic floor disorders Yes ! It´s a tool to detect almost all pelvic floor disorders The only limitation is in upper bowel disorders (for example Cul-de-sac) In case of this – use a classic defecography MAGEN DARM ZENTRUM WIENER PLATZ 27

Proceeding this way all patients with pelvic floor disorders can be conduct to the right therapy physiotherapy surgery proctology urology gynecology MAGEN DARM ZENTRUM WIENER PLATZ 28

Thank you for attention ! MAGEN DARM ZENTRUM WIENER PLATZ 29

MAGEN DARM ZENTRUM WIENER PLATZ In cooperation with and MAGEN DARM ZENTRUM WIENER PLATZ 30

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