Sonovaginography Helps Detect Rectovaginal Endometriosis

Laurie Barclay, MD

April 25, 2003

April 25, 2003 — The instillation of saline to distend the vagina during transvaginal ultrasound markedly improves the sensitivity and specificity for identifying rectovaginal endometriosis, according to the results of a prospective study published in the April issue of Fertility & Sterility.

"Transvaginal ultrasonography can detect endometriotic foci, but its sensitivity is poor for the diagnosis and workup of posterior pelvic lesions," write Salvatore Dessole, MD, from the University of Sassari in Italy, and colleagues. "Sonovaginography is a reliable and simple method for the assessment of rectovaginal endometriosis and provides information on location, extension, and infiltration of the lesions, which are important factors in selecting the kind of surgery."

Before laparotomic or laparoscopic surgery for clinically suspected rectovaginal endometriosis, 46 women had transvaginal ultrasonography followed by sonovaginography. The latter technique introduces saline into the vagina to create an acoustic window between the transvaginal probe and the surrounding structures of the vagina.

Patient discomfort was similar for both procedures. However, sonovaginography was more accurate than transvaginal ultrasonography in diagnosing rectovaginal endometriosis at surgery (sensitivity, 90.6% vs. 43.7%; specificity, 85.7% vs. 50%; positive predictive value, 93.5% vs. 66.6%; negative predictive value, 80.0% vs. 28.0%).

"These preliminary results strongly encourage the use of this technique in the assessment of rectovaginal endometriosis," the authors suggest, despite the small sample size and the need for further studies.

"This technique can also distinguish those lesions that are not placed in the true rectovaginal septum but in the vaginal portion of the rectovaginal pouch," they write. "A slight distension of the bladder creates a further acoustic window, which allows more accurate visualization of the anterior vaginal wall and of vesicovaginal septum."

Fertil Steril. 2003;79:1023-1027

Reviewed by Gary D. Vogin, MD

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