14/02/2021 at 7:59 pm #10636
I got a severe case of prolapsed uterus where the whole of uterus is outside of the pelvic cavity and I can measure the whole length of it. For this type of translabial study, what would be your protocol?
Would you assess to see if there is a cystocele/rectocele with Valsalva? What pathologies/things would you look for?
Do you use a curve array probe (6-1mHz)? What would you use to ensure good infection control?
17/02/2021 at 11:54 pm #10807
To be honest this probably doesn’t need an ultrasound at all,
If the uterus is prolapsed by such a degree it is a clinical diagnosis and the gynaecologist team can manage the patient medically and surgically as appropriate.
If you do a trans perineal scan I use a convex transducer like i use for imaging the liver etc. I put gel on the transducer and then place a sterile plastic bag over the transducer. Then more gel on the outside. The el on the outside is a sachet of sterile gel, however you are not scanning in a sterile field anyway.
When I finish the scan I remove the plastic bag and wash the transducer in warm soapy water. Then I dry it and sterilise it in a Trophon machine (nannosonics product) then it is ready to be used again.
On the trans perineal study during valsalva you will observe the cervix and uterus undergoing abnormal descent towards the transducer.
If there is a cystocele you will also see the bladder neck anterior to the vagina descending below the level of the symphysis pubis and if it is a cystourethrocele the urethra will rotate into a more vertical position (parallel to the transducer face) as the bladder neck descends.
If there is a rectocele you will see the anterior border of the rectum adjacent to the recto-vaginal septum bulging anteriorly during valsalva.
In my experience with such a large uterine prolapse the other pathologies in the anterior and posterior compartment will be difficult to assess due to the space occupying effect of the prolapsed uterus.
20/02/2021 at 9:44 pm #10949
I honestly could not make out the anatomy except for the bladder and uterus in that case. I was afraid that Valsalva would cause more pelvic contents to exit. Pelvic floor imaging is definitely not done enough so it is hard to learn and then perform adequately when things do come up. Thanks for outlying the things to look for Steve.
20/02/2021 at 11:52 pm #10953
I will get around to recording my pelvic floor lecture soon and you can enjoy it on the website.
It is just a basic overview style lecture but the knowledge is really useful when you are performing gynae ultrasound or renal ultrasound and some sort of prolapse is the likely problem.
23/02/2021 at 9:21 pm #11129
Thanks Steve, I vaguely remember you talked about all the celes/’seals’ at a workshop. Sorry I zoned out. Didn’t expect I need to know them someday.
23/02/2021 at 9:40 pm #11132
I will record that lecture into a webinar for the website and you will understand all the “celes” !
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