Morphological and functional pelvic floor defects from a gynaecological viewpoint

Purpose. The following article is designed to describe the diagnostics and therapy of morphological and functional defects in the female pelvic door f rom a gynaecological point of view. Assessment of the relevance of imaging techniques is of particular importance. Material and methods. The main diagnoses are:in the anterior compartment of the pelvic floor, urethro-cystocele; in the middle compartment, uterine de scent/prolapse or enterocele; and in the posterior compartment, rectocele. They are clinically examined by means of a standardised gynaecological exam ination and classified according to recommendations from the international Continence Society (ICS) in order to obtain internationally comparable resu lts. Comparison with the usual imaging procedures (introitus- and perineal sonography, colpocysto-rectography/defaecography and functional MRI of the pelvic floor) are described and critically discussed. The most important fu nctions affected are storage and evacuation of the bladder and rectum. They are clinically examined by means of stress test and pad-weigh test and tec hnically examined using urodynamics, sphincter-rectum manometry and EMG. Im aging procedures play a very important role here also. Results. Comparison of clinical and imaging procedures shows that the two m ethods are at present limited in comparability, mainly because different po ints of reference are used to quantify results. The line of the hymen is a good point of reference in grading descent and prolapse. During the gynaeco logical examination,the three compartments can readily be assessed separate ly by use of split gynaecological specula. This is presently practically im possible using imaging procedures. The pubococcygeal line is generally used to describe findings. Discussion. Scientific progress can only be expected if and when these prob lems are studied as a whole. Imaging procedures have securely established t hemselves in the diagnostic repertoire, but do not as yet influence therapy decisions. The indication and choice of operation depend on the severity o f the patient's symptoms the clinical findings and the results of urodynami c investigations. Dynamic CTG is presently the most reliable method of show ing all three compartments at rest and during function. It has largely repl aced colpocystorectography. Sonography is found to be varied in ist results at the moment.