EP10.06: Sonovaginography in differential diagnosis of vaginal and paravaginal abnormalities: preliminary results

To share the experience and results of sonovaginography (SVG) of our centre. SVG consists in the instillation of 10–20 ml of ultrasound gel or saline into the vaginal vault, followed by endovaginal sonography. The acoustic window created between the transvaginal probe and the vaginal walls allows better characterisation of anterior and posterior vaginal fornices, anterior and posterior vaginal walls, retrocervical area, uterosacral ligaments, pouch of Douglas, rectovaginal septum, rectosigmoid colon e perivesical space. Although principal indications for SVG are pelvic symptoms associated with endometriosis and exclusion of deep infiltrating disease, it also may be helpful in clarifying other entities, like integrity of vaginal walls, paravaginal tumors and vaginal symptoms in postoperative period. Review of clinical reports of all patients that performed SVG between November 2013 and March 2015. In that period 47 exams were performed. As expected, the major indication was endometriosis (59.6%), suspected or confirmed. In 64.3% of those cases findings suggestive of deep infiltrating disease were present. Other indications were: vaginal wall tumor (10.6%), suspected postoperative complication (10.6%), vaginal dysplasia or cytohistocolposcopic discordance in follow up of vaginal vault after hysterectomy for cervical dysplasia (8.5%), suspected recurrence of malignant neoplasia (4.3%), superficial dyspareunia (4.3%) and confirmation of fistulas involving vagina (2.1%). SVG is a safe, inexpensive and easily performed procedure. Abnormalities that are not apparent on clinical pelvic exam or standard endovaginal or transperineal sonography can be readily identifiable with sonovaginography. When added as a supplement to pelvic sonography, the diagnostic evaluation of vaginal and paravaginal abnormalities is improved.