Pelvic Floor Dysfunction

Pelvic floor dysfunction (PFD) is a general term for a variety of clinical disorders, including urinary incontinence (UI), pelvic organ prolapsed (POP) (Fig. 49.1), fecal dysfunction, lower urinary tract sensory and emptying abnormalities, sexual dysfunction, and some chronic pelvic pain syndromes. More than 15% of multiparous women are affected by the disease. The risk factors for PFD include vaginal delivery, multiparity, hysterectomy, advanced age, and chronic obstructive pulmonary disease, among which vaginal delivery and advanced age are the most correlated risk factors [1]. With increasing life expectancy, the negative effect of PFD on the health care system in terms of cost, productivity, and quality of life is critical. The clinical evaluation of PFD is mainly performed by using the POP quantification system, which demonstrated low sensitivity and specificity for the diagnosis of complex alterations [2]. The accuracy of clinical diagnosis directly affects the formulation of surgical plan, which is also one of the important reasons for associated surgical failure and high recurrence rates. Traditional techniques for PFD include assessment of the bladder and levator ani muscle (Fig. 49.2) by transvaginal ultrasonography (US), urodynamic test, and vesicovaginal defecography. During the past decade, three-dimensional (3D) and four-dimensional (4D) translabial ultrasonography and magnetic resonance imaging (MRI) have been used to accurately assess pelvic floor anatomy and function, enabling evaluation of all three pelvic compartments simultaneously. MRI has excellent soft tissue and time resolution and can evaluate the organs, muscles, and ligaments in the pelvic cavity in multiplanar without ionizing radiation.