Modern ultrasound imaging of pelvic floor dysfunction: clinical applications and capabilities

Background. Pelvic floor dysfunction (PFD) encompasses a heterogeneous group of disorders resulting from damage to the supporting structures of the pelvic organs, including pelvic organ prolapse, urinary incontinence, fecal incontinence, defecatory disorders, and sexual dysfunction, which often co-occur and require comprehensive evaluation and treatment.

Objective. To evaluate the role of pelvic floor ultrasound in the diagnosis, phenotyping, and treatment planning of pelvic floor dysfunction in obstetric and gynecological practice.

Methods. A narrative literature review was conducted analyzing studies on transperineal, translabial, transvaginal, endoanal, and integrated pelvic floor ultrasound approaches. The search was performed in PubMed, Scopus, and Cochrane databases.

Results. Pelvic floor ultrasound provides dynamic, non-invasive imaging of pelvic floor anatomy and function without ionizing radiation. The method allows assessment of bladder neck mobility, urethral support, levator ani muscle integrity, levator hiatus dimensions, pelvic organ descent, posterior compartment pathology, as well as the position of postoperative mesh implants and slings. Three-dimensional (3D) and four-dimensional (4D) technologies improve anatomical reconstruction and reduce operator dependence.

Conclusion. Pelvic floor ultrasound has become an important first-line imaging modality for pelvic floor dysfunction due to its safety, accessibility, reproducibility, and utility for both diagnosis and individualized treatment selection. Its role is increasing in conservative management, surgical planning, postpartum assessment, and biofeedback-guided rehabilitation.

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