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Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Defecating proctography has been traditionally used to assess patients with evacuatory dysfunction. More recently, dynamic transperineal ultrasound has been described, defining the interaction between the infralevator viscera and the pelvic floor at rest and during straining. This study compared qualitative diagnosis and quantitative measurement obtained by defecography and dynamic transperineal ultrasonography in patients with evacuatory difficulty.

Patients and methods

Thirty-three women were examined using both techniques with both examiners blinded to the results of the other method. Quantitative measurement was made of rectocele depth, anorectal angle (at rest and during maximal straining) and anorectal junction position at rest and movement during straining.

Results

There was good agreement for the diagnoses of rectocele, rectoanal intususseption, and rectal prolapse. Dynamic transperineal ultrasound was more likely than defecography to make multiple diagnoses or to diagnose an enterocele when a rectocele was present. There was no difference noted between the two techniques for the measurement of anorectal angle at rest, anorectal junction position at rest, or anorectal junction movement during straining. The mean anorectal angle during straining was 123.3±4.3° as measured by defecography and 116.4±3.3° as measured by dynamic transperineal ultrasound, nearly reaching statistical significance.

Conclusion

Dynamic transperineal ultrasound is a simple and accurate technique for assessment of the pelvic floor and soft-tissues in patients with evacuatory dysfunction.

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References

  1. Felt-Bersma RJ, Luth WJ, Janssen JJ, Meuwissen SG (1990) Defecography in patients with anorectal disorders. Which findings are clinically relevant? Dis Colon Rectum 33:277–284

    Google Scholar 

  2. Siproudhis L, Ropert A, Vilotte J, Bretagne JF, Heresbach D, Raoul JL, Gosselin M (1993) How accurate is clinical examination in diagnosing and quantifying pelvirectal disorders? A prospective study in a group of 50 patients complaining of defecatory difficulties. Dis Colon Rectum 36:430–438

    PubMed  Google Scholar 

  3. Kelvin FM, Hale DS, Maglinte DD, Patten BJ, Benson JT (1999) Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR Am J Roentgenol 173:31–37

    CAS  PubMed  Google Scholar 

  4. Lienemann A, Anthuber C, Baron A, Kohz P, Reiser M (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol 7:1309–1317

    Article  CAS  PubMed  Google Scholar 

  5. Healy JC, Halligan S, Reznek RH, Watson S, Bartram CI, Phillips R, Armstrong P (1997) Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR Am J Roentgenol 169:775–779

    CAS  PubMed  Google Scholar 

  6. Healy JC, Halligan S, Reznek RH, Watson S, Bartram CI, Phillips R, Armstrong P (1997) Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR Am J Roentgenol 169:775–779

    CAS  PubMed  Google Scholar 

  7. Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9:373–377

    Article  CAS  PubMed  Google Scholar 

  8. Schoenberger AW, Debatin JF, Guldenschuh I, Hany TF, Steiner P, Krestin GP (1998) Dynamic MR defecography with a superconducting, open-configuration MR system. Radiology 206:641–646

    PubMed  Google Scholar 

  9. Rubens DJ, Strang JG, Bogineni-Misra S, Wexler IE (1998) Transperineal sonography of the rectum: anatomy and pathology revealed by sonography compared with CT and MR imaging. AJR Am J Roentgenol 170:637–642

    CAS  PubMed  Google Scholar 

  10. Kleinübing H Jr, Jannini JF, Malafaia O, Brenner S, Pinho M (2000) Transperineal ultrasonography: new method to image the anorectal region. Dis Colon Rectum 43:1572–1574

    PubMed  Google Scholar 

  11. Piloni V (2001) Dynamic imaging of the pelvic floor with transperineal sonography. Tech Coloproctol 5:103–105

    CAS  PubMed  Google Scholar 

  12. Beer-Gabel M, Teshler M, Barzilai N, Lurie Y, Malnick S, Bass D, Zbar AP (2002) Dynamic trans-perineal ultrasound (DTP-US)—a new method for the diagnosis of pelvic floor disorders: technical details and preliminary results. Dis Colon Rectum 45:239–248

    PubMed  Google Scholar 

  13. Favetta U, Amato A, Interisano A, Pescatori M (1996) Clinical, manometric and sonographic assessment of the anal sphincters: a comparative prospective study. Int J Colorectal Dis 11:163–116

    Article  CAS  PubMed  Google Scholar 

  14. Zbar AP, Aslam M, Gold DM, Gatzen C, Gosling A, Kmiot WA (1998) Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation. Dis Colon Rectum 41:200–208

    CAS  PubMed  Google Scholar 

  15. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749

    CAS  Google Scholar 

  16. Peschers UM, DeLancey JO, Schaer GN, Schuessler B 1997) Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol 104:999–1003

    Google Scholar 

  17. Pitman JS, Benson JT, Sumners JE (1990) Physiologic evaluation of the anorectum: a new ultrasound technique. Dis Colon Rectum 33:476–478

    PubMed  Google Scholar 

  18. Kenton K, Shott S, Brubaker L (1999) The anatomic and functional variability of rectocele in women. Int Urogynecol J Pelvic Floor Dysfunction 10:96–99

    CAS  Google Scholar 

  19. Mellgren A, Johansson C, Dolk A, Anzen B, Bremmer S, Nilsson BY, Holmstrom BY, Holmstrom B (1994) Enterocele demonstrated by defecography is associated with other pelvic floor disorders. Int J Colorectal Dis 9:121–124

    CAS  PubMed  Google Scholar 

  20. Bremmer S, Mellgren A, Holmstrom B, Uden R (1998) Peritoneocele and enterocele: formation and transformation during rectal evacuation studied by means of defaeco-peritoneography. Acta Radiol 39:167–175

    Google Scholar 

  21. Jorge JM, Ger GC, Gonzales L, Wexner SD (1994) Patient position during cinedefecography: influence on perineal descent and other measurements. Dis Colon Rectum 37:927–931

    CAS  Google Scholar 

  22. Dietz HP, Clarke B (2001) The influence of posture on perineal ultrasound imaging parameters. Int Urogynecol J Pelvic Floor Dysfunct 12:104–106

    CAS  PubMed  Google Scholar 

  23. Matsuoka H, Wexner SD, Desai MB, Nakamura T, Nogueras JJ, Weiss EG, Adami C, Billotti VL (2001) A comparison between dynamic magnetic resonance imaging and videoproctography in patients with constipation. Dis Colon Rectum 44:571–576

    CAS  PubMed  Google Scholar 

  24. Knowles CH, Eccersley AJ, Scott SM, Walker S, Reeves B, Lunniss PD (2000) Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Dis Colon Rectum 43:1419–1426

    Google Scholar 

  25. Lo VH, Ho LM, Fried KS (1999) Vaginal opacification during defecography: direction of vaginal migration aids in diagnosis of pelvic floor pathology. Abdom Imaging 24:565–568

    Article  CAS  PubMed  Google Scholar 

  26. Kelvin FM, Maglinte DD, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88

    CAS  PubMed  Google Scholar 

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Correspondence to A. P. Zbar.

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Beer-Gabel, M., Teshler, M., Schechtman, E. et al. Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study. Int J Colorectal Dis 19, 60–67 (2004). https://doi.org/10.1007/s00384-003-0508-x

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  • DOI: https://doi.org/10.1007/s00384-003-0508-x

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