Figure 6.2 demonstrates the normal ultrasonic disposition of the female pelvic organs, namely, normal position of pubic symphysis, bladder, urethra, vagina, uterus, and rectum.

Although the use of pelvic ultrasound in assessing POP is not new and has been used in many academic centres in discovering and describing many anatomical defects utilizing many different research parameters [2–4], the pelvic floor reconstructive surgeon should also apply it in everyday clinical practice. One of the advantages of possessing ultrasound skills in routine clinical practice is that it can immediately add to the information which the clinician has already obtained in the history and physical examination. This advantage can come in the form of:

Armed with this extra information immediately available at the bedside, the reconstructive surgeon can better understand the disease process behind each vaginal compartment, correlate it with the patient’s symptomatology, and thus offer a more expedited and streamlined approach to management. In cases of recurrent POP after mesh repairs, ultrasound can often help the surgeon in understanding why the particular mesh failed, and this can allow the surgeon to reflect on whether it was a technical failure which he/she can improve on in future cases. This aspect has impact on quality improvement, continued professional development, and better patient care.

As for imaging mid-urethral slings, the transducer is placed on perineum, at the introitus (see Figs. 5.​2 and 5.​3). The bladder should be adequately filled. Valsalva manoeuvres are then used to assess the most dependent point of the prolapse in each of the three vaginal compartments so that a POP-Q assessment (Fig. 6.3) can be possible. Slings and pelvic organ prolapse meshes should be easily identified as a hyperechoic area in their respective areas (see Case 2). Scanning position should be in both supine and standing with full bladder if preferable, and take utmost care not to cause discomfort with pressure on the introitus which may also distort anatomy. Dynamic imaging will help to elicit location of the mesh, especially in failed cases, and to assess severity of the POP and how the mesh moves with straining.