Figure 1

Transperineal ultrasound image of female pelvic floor anatomy. The mid-sagittal plane (A) and axial plane (B) of the pelvic floor. SP, symphysis pubis; U, urethra; BL, bladder; V, vagina; C, cervix; A, anal canal; R, rectal ampulla; LAM, levator ani muscle."

Figure 2

Determination of pelvic floor organs mobility and hiatal area. Ultrasound images show the mid-sagittal plane at rest (A, C) and on Valsalva (B, D, E), and a rendered axial plane on Valsalva (F). RL, reference line, indicates the interior symphyseal margin; d1-d1’, d2-d2’, d3-d3’ demonstrate the measurements of distances between the RL and bladder neck, cervix and rectal ampulla at rest and on maximal Valsalva, respectively; a1-a1’, a2-a2’ show the tilt angle and the retro-vesical angle of the urethra at rest and on maximal Valsalva. The yellow dotted curve in (F) indicates the hiatal area."

Figure 3

Normal pelvic floor showing 8 axial plane slices set at 2.5 mm interslice interval, with the central slice at the level of the plane of minimal hiatal dimension, showing the closure of the symphysis pubis (white arrows)."

Figure 4

Tomographic imaging of a normal anal sphincter. A set of 8 slices is obtained from the level of the puborectalis muscle to the level of the subcutaneous component of the EAS to bracket the entire EAS. The left arrow indicates the caudad termination of the IAS, and the right arrow indicates the dorso-cranial termination of the EAS. Slice thickness is adjusted individually to include slices from above the EAS to below the IAS. The EAS is represented by slices 2-7, with slice 1 showing the subcutaneous part of the EAS which often is difficult to interpret due to artefact. EAS, external anal sphincter; IAS, internal anal sphincter."

Figure 5

Unilateral major left-sided levator avulsion (marked by arrow) on tomographic ultrasound imaging. The defect is visible in all slices of the image. There also is minor right-sided trauma in slices 1-3."

Figure 6

A residual defect of the external anal sphincter on tomographic ultrasound imaging. From 2 to 5 slices of the image (with angle measurements) show a defect of > 30 degrees."

Figure 7

Mid-urethral sling (arrow) in the midsagittal plane at rest (A) and on maximal Valsalva (B), and the rendered axial plane on maximal Valsalva (C). The distance measurement in (B) shows the sling-pubis gap, the most suitable measure of sling ‘tightness’. In this case, it is about average at 1 cm. SP, symphysis pubis; BL, bladder; A, anal."

Figure 8

Mid-sagittal planes (A, B) and axial plane (C) of patient with anterior and posterior vaginal mesh. The anterior mesh is visible dorsal to the proximal urethra and trigone (the left arrows in image ‘A, B’ and the above arrows in image ‘C’), the posterior mesh anterior to the rectal ampulla (the right arrows in image ‘A, B’ and the below arrows in image ‘C’). At rest (A), both meshes are in normal shape and position; on Valsalva (B), there is a significant recurrent enterocele in the posterior compartment."