[Morphologic assessment for diagnosing urogynaecologic disorders].

Morphologic assessment for diagnosing urogynecologic disorders is done as part of the gynecologic examination and urogenital ultrasound with the equipment available in the gynecologist's office. Evaluation of the pelvic floor by separate palpation of both sides, assessment of contractility, testing of speculum elevation, and ultrasound examination of voluntary motor function by elevation of the bladder neck during muscle contraction provide adequate information on the pelvic floor status for initiating pelvic floor re-education and/or conditioning. In assessing prolapse, differentiation of a lateral defect from a central defect of the anterior compartment is an important prerequisite for surgical decision-making in stress urinary incontinence (colposuspension versus TVT-plasty) and urogenital prolapse (abdominal versus vaginal access). Introitus or perineal ultrasound allow for reliable assessment of the topography of the bladder neck and will also demonstrate morphologic changes of the urethra, the periurethral tissue, and the bladder. - Radiographic examinations (e. g., excretory urography, double-balloon urethrography, micturition cystourethrography, retro- and antegrade depiction of fistulae) are not part of the basic diagnostic work-up and should only be performed in the framework of specific urogynecologic assessment. These procedures are indicated for assessing the upper urinary tract, for confirming the diagnosis of urethral diverticulae, and for clarifying extraurethral urinary incontinence. - Magnetic resonance imaging allows for the detailed morphologic assessment of the levator ani muscle, the endopelvic fascia, and the urethra. However, since normal values for comparison have not yet been established and the examination is complicated and expensive, the use of MRI is still restricted to scientific investigations.