eP622 - Can Transperineal Ultrasound Be Used as a Screening Tool to Identify Patients in Whom Transvaginal Ultrasound Can Be Avoided?

Purpose/Background: Integrated total pelvic floor ultrasound(TPFUS) consists of transperineal (TPUS), transvaginal (TVUS), endovaginal and endoanal ultrasound for the dynamic assessment of the entire pelvic floor. Transperineal ultrasound allows the visualisation of all three pelvic floor compartments in real-time and is a fast, effective, non-invasive and well-tolerated investigation. By contrast, transvaginal ultrasound is invasive and may duplicate many negative findings already appreciated during transperineal scanning. We hypothesised that in patients with symptoms of pelvic floor disorders, the negative predictive value (NPP) of transperineal ultrasound to detect pathology on transvaginal ultrasound is >90%.Methods/Interventions: This is a single-institution, retrospective study of female patients with multi-compartmental pelvic floor symptoms who underwent TPUS and TVUS in a tertiary colorectal pelvic floor unit at Guy’s and St Thomas’ Hospital, London. Findings from TPUS and TVUS were compared to assess the presence or absence of structural abnormalities observed, such as pathological rectocoele (>2cm), pathological intussusception(grade > III), enterocoele, cystocele and bladder neck descent. We also determined if there was any association between propulsion and co-ordination and detection of a structural abnormality on both TPUS and TVUS. Data was analysed after excluding missing values, where p-value < 0.05 was considered significant.Results/Outcomes: We collected data for 865 TPUS and TVUS performed between March 2012 and September 2023. A total of 390 (45%) pathological rectocoele, 128 (14.8%) enterocoele and 395 (45.72%) cystocoele were observed on TPUS, while 427 (49.4%) rectocoele, 64 (7.4%) enterocoele and 223 (25.8%) pathological intussusception were observed on TVUS.We found that the likelihood of finding an enterocele on TVUS was 2.2% when no enterocoele was found on TPUS (NPV = 97.8%). The probability of finding a rectocoele on TVUS was 27.8% when no pathological rectocoele was found on TPUS (NPV = 72.2%). However, 98.5% of the rectocoele observed on TVUS when TPUS did not show any pathological rectocoele were non-pathological ( < 2cm). The possibility of finding poor bladder neck support on the anterior view of TVUS was 5.8% when no cystocele was observed on TPUS (NPV = 94.2%).Patients with poor propulsion and coordination were less likely to have structural abnormalities detected, such as pathological rectocoele, cystocele and pathological intussusception on both TPUS and TVUS (p-value < 0.001).Table 1 demonstrates the comparison of findings from both TPUS and TVUS. It also demonstrates the association between observed structural abnormalities and propulsion and coordination.Conclusion/

Discussion: We demonstrated that TVUS can be avoided in patients whose TPUS did not show physiological variations from normal anatomy. Future prospective research along with this study will provide preliminary data to help clinicians predict and plan the need for invasive TVUS based on the findings on TPUS, where observations can be underreported if propulsion and co-ordination are poor.Table 1 for abstractTable 1 demonstrates comparison of findings from both TPUS and TVUS. It also demonstrates the association between propulsion co-ordination and observing structural abnormalities