P28.06: Does 3D/4D transperineal ultrasound add to the pre‐operative transvaginal ultrasound evaluation in women undergoing surgery for endometriosis?

To evaluate whether 3D/4D transperineal ultrasound of the levator ani adds to the pre-operative transvaginal evaluation of women undergoing surgery for endometriosis. Women referred for pre-operative evaluation at a large endometriosis center underwent a transvaginal ultrasound scan, and 3D/4D transperineal pelvic floor ultrasound for levator assessment. Volumes were acquired at rest, maximal Valsalva, and pelvic floor contraction. Rendered views of the levator were analyzed for any finding affecting levator morphology and function. A diagnosis of endometriosis which required surgery was made based on clinical criteria and findings at the time of the ultrasound scan, and women subsequently underwent laparoscopic surgery. Ninety four volumes were available, with mean age 34 (20-47), median parity 0 (0-6), mean BMI 23.6 (16.9-40.23); 52 (55.5%) were nulliparous, 10 (12.8%) after Caesarean sections. Symptoms and complaints: dysmenorrhea (92.5%), dyspareunia (64.1%), urinary complaints (28.6%), gastrointestinal complaints (53.8%) and infertility (37.2%). On the transperineal levator rendered volume, three (3.1%) women had avulsion defects. Mean levator thickness was 7 ± 1.4 and 7.3 ± 1.6 mm on the right and left sides, respectively. Five women had findings in the posterior part of the puborectalis sling of the levator, with distorted levator morphology by adjacent lesions: adhesions involving large endometriomas and sacrouterine ligaments in three women, a large adenomyoma in one, and a large rectosigmoid nodule involving both sides of the levator with Douglas pouch blockage in another. The additional time required to perform the volume rendering was five minutes. Transperineal volume rendering of the levator adds important information with regards to morphology and mapping of endometriosis lesions involving the pelvic organs and their supporting structures, without adding significantly to the examination time.