We read with interest the Editorial by Yagel and Valsky about three-dimensional transperineal ultrasonography1.

Unfortunately, according to our experience, transperineal ultrasound has a low spatial resolution. During surgical planning, it is important to obtain an optimal resolution, particularly when injuries of the anal sphincter complex are present. In comparison, endoanal sonography has a good spatial resolution, producing a 360° view of the perianal region. However, although it allows an axial view of the perianal structures, it does not permit a mid-sagittal view.

In the last decade, vaginal endosonography has been introduced as an alternative technique for imaging the posterior pelvic floor, particularly the anorectal architecture2, 3. However, only static studies have been performed3. For this reason, we have used vaginal endosonography to carry out a dynamic evaluation of the posterior pelvic floor, together with a static assessment of the related anatomical structures in preoperative planning. We found that vaginal endosonography can be used to evaluate the anorectum, yielding a good spatial resolution, particularly in young women, with no preparation required. We observed limitations in the presence of severe rectal or vaginal prolapse. In the sagittal view, vaginal endosonography can also offer dynamic information during squeezing and straining. The anorectal junction can be examined at rest, during squeezing, and during sustained straining. The anorectal angle, defined as the angle formed between the posterior wall of the rectum and the anal canal, can also be measured. We think that a three-dimensional approach to vaginal endosonography performed with a dynamic study could offer better spatial resolution than that described by Yagel and Valsky.


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R. F. Grasso*, S. Piciucchi*, C. C. Quattrocchi*, B. Beomonte Zobel*, * Radiology, Università Campus Bio-Medico di Roma, via Longoni, 47, Rome, Lazio 00155, Italy