Integrated Imaging Approach to Pelvic Organ Prolapse

Pelvic floor is still artificially divided into anterior, middle, and posterior compartments; however, abnormalities in one compartment frequently coexist with disorders in the other two compartments. Due to its complex anatomy and function, pelvic floor should be approached with a unitary vision by a multidisciplinary team of colorectal surgeons, urologists, urogynecologists, and radiologists. Imaging leads to a better understanding of the pathophysiology of pelvic floor disorders and helps clinicians to select the most adequate treatment and to understand the reasons of failures or recurrences. Integration and combination of different modalities (X-ray, ultrasound, and magnetic resonance imaging) provides comprehensive assessment of pelvic organ prolapse. Ultrasound may be performed with endovaginal, transperineal, and endoanal approaches. Technological innovations such as high-resolution 3D or 4D ultrasound, new software options, and data post-processing capabilities have further increased the accuracy of this procedure. However, the place of imaging in diagnostic algorithms of pelvic floor disorders is still controversial and often differs among specialties. The challenge for specialties dealing with patients with POP is that integrated imaging approach becomes part of the routine clinical practice.