Transvaginaltransrectal

Transvaginaltransrectal is a term used to describe a combined pelvic ultrasound assessment that uses both transvaginal and transrectal approaches in the same examination. It is not a distinct imaging modality but a protocol to enhance visualization of pelvic anatomy when comprehensive assessment is required or when imaging via a single approach is limited.

Indications for this approach include evaluation of pelvic pain, abnormal uterine bleeding, adnexal masses, and infertility workups, as well as assessment of deep infiltrating disease or tumor spread where visualization of posterior pelvic structures or the rectovaginal region is needed. It may be chosen when standard transvaginal imaging does not provide sufficient detail or when a broader survey of the pelvis is desired.

Procedure typically begins with transvaginal ultrasound, using a sterile vaginal probe with the bladder in a clinically appropriate state. After completion of TVUS, a transrectal examination may be performed with a sterile lubricated rectal probe, often with the patient in the left lateral decubitus position, to obtain complementary views of posterior structures and adjacent regions. The examination concludes once adequate visualization has been achieved.

Safety and limitations: the risks are low and mainly related to mild discomfort; infection risk is minimal with proper sterile technique. Not all patients are suitable for the transrectal portion due to contraindications or intolerance. Image quality depends on operator experience and patient anatomy, and the combined approach may require additional time and coordination.