ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

Area of Science:

• Radiology and Imaging
• Gynecology
• Urology

Background:

• Pelvic floor disorders (PFDs) like pelvic organ prolapse (POP), urinary, and defecatory dysfunction are common in women.
• Imaging is indicated when clinical evaluation is inconclusive or discordant with symptoms.
• An integrated imaging approach is essential for assessing complex pelvic floor anatomy and dynamic function.

Framework:

• Fluoroscopic cystocolpoproctography (CCP) and MR defecography are primary imaging choices for POP and defecatory dysfunction.
• Fluoroscopic voiding cystourethrography is the initial test for urinary dysfunction.
• MRI pelvis and MR defecography are initial tests for complications after pelvic floor surgery.

Implementation:

• Transperineal ultrasound is an emerging tool for PFD screening and evaluating surgical complications (e.g., midurethral slings, vaginal mesh).
• Ultrasound pelvis transrectal is a complementary test for anal sphincter defects.
• Imaging guidelines are based on evidence-based methodologies like RAND/UCLA and GRADE, supplemented by expert opinion when needed.

Implications:

• Appropriate imaging selection ensures accurate diagnosis and guides treatment for various pelvic floor disorders.
• Standardized, evidence-based guidelines improve the consistency and quality of PFD imaging.
• Further research may refine imaging protocols for complex PFD cases and surgical outcomes.