Skip to main content

Advertisement

SpringerLink
Log in

Dynamic transperineal ultrasonography correlates with prolonged pudendal nerve latency in female with fecal incontinence

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

The pelvic floor is a complex anatomical entity and its neuromuscular assessment is evaluated through debated neurophysiological tests. An innovative approach is the study of pelvic floor through dynamic transperineal ultrasound (DTU). The aim of this study is to evaluate DTU sensitivity in recognizing patients with fecal incontinence and to evaluate its concordance with the results of the motor latency studied via pudendal nerve terminal motor latency (PNTML). Female patients affected by FI addressed to our center of coloproctology were prospectively assessed. After a coloproctological evaluation, comprising the PNTML assessment to identify pudendal neuropathy, patients were addressed to DTU to determine anterior and posterior displacement of puborectalis muscle by a blinded coloproctologist. In order to compare the data, a cohort of female healthy volunteers was enrolled. Sixty-eight subjects (34 patients and 34 healthy volunteers) were enrolled. The sensitivities of anterior displacement, posterior displacement and either anterior or posterior displacement in determining the fecal incontinence were 82%, 67% and 91%, respectively. A further high correlation of either anterior or posterior displacement with PTNML was also noted (88%). DTU is an indirect, painless and reproducible method for the identification of the pelvic floor neuromuscular integrity. Its findings seem to highly correlate with FI symptoms and with PNTML results. In the near future, after larger comparative studies, DTU would be considered a potential reliable non-invasive and feasible indirect procedure in the identification of fecal incontinence by pudendal neuropathy. Trial registration number is NCT03933683.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, LB, upon reasonable request.

References

  1. Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN (2004) Long-term results of anterior sphincteroplasty. Dis Colon Rectum 47(5):727–731 (discussion 731–732. PMID: 15037931)

    Article  Google Scholar 

  2. Zufferey G, Perneger T, Robert-Yap J, Rubay R, Lkhagvabayar B, Roche B (2009) Measure of the voluntary contraction of the puborectal sling as a predictor of successful sphincter repair in the treatment of anal incontinence. Dis Colon Rectum 52(4):704–710. https://doi.org/10.1007/DCR.0b013e31819d46a6

    Article  PubMed  Google Scholar 

  3. Roche B, Deléaval J, Fransioli A, Marti MC (2001) Comparison of transanal and external perineal ultrasonography. Eur Radiol 11(7):1165–1170 (PMID: 11471606)

    Article  CAS  Google Scholar 

  4. Zufferey G, Perneger T, Robert-Yap J, Skala K, Roche B (2011) Accuracy of measurement of puborectal contraction by perineal ultrasound in patients with faecal incontinence. Colorectal Dis 13(8):e234–e237. https://doi.org/10.1111/j.1463-1318.2011.02645.x

    Article  CAS  PubMed  Google Scholar 

  5. de Aguiar CG, Manzano GM, Nunes KF, Giuliano LM, de Menezes TA, Bruschini H (2013) Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence. Int Urogynecol J 24(5):801–807. https://doi.org/10.1007/s00192-012-1931-8

    Article  Google Scholar 

  6. Cooper EA, De-Loyde KJ, Young CJ, Shepherd HL, Wright C (2016) Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence. Int J Colorectal Dis 31(8):1437–1442. https://doi.org/10.1007/s00384-016-2617-3

    Article  PubMed  Google Scholar 

  7. Diamant NE, Kamm MA, Wald A, Whitehead WE (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116(3):735–760 (PMID: 10029632)

    Article  CAS  Google Scholar 

  8. Sangwan YP, Coller JA, Barrett RC, Roberts PL, Murray JJ, Rusin L, Schoetz DJ Jr (1996) Unilateral pudendal neuropathy. Impact on outcome of anal sphincter repair. Dis Colon Rectum 39(6):686–689 (PMID: 8646958)

    Article  CAS  Google Scholar 

  9. Gilliland R, Altomare DF, Moreira H Jr, Oliveira L, Gilliland JE, Wexner SD (1998) Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum 41(12):1516–1522 (PMID: 9860332)

    Article  CAS  Google Scholar 

  10. Roy AL, Gourcerol G, Menard JF, Michot F, Leroi AM, Bridoux V (2014) Predictive factors for successful sacral nerve stimulation in the treatment of fecal incontinence: lessons from a comprehensive treatment assessment. Dis Colon Rectum 57(6):772–780. https://doi.org/10.1097/DCR.0000000000000115

    Article  PubMed  Google Scholar 

  11. Rothbarth J, Bemelman WA, Meijerink WJ, Buyze-Westerweel ME, van Dijk JG, Delemarre JB (2000) Long-term results of anterior anal sphincter repair for fecal incontinence due to obstetric injury/with invited commentaries. Dig Surg 17(4):390–393. https://doi.org/10.1159/000018883(discussion 394)

    Article  CAS  PubMed  Google Scholar 

  12. Buie WD, Lowry AC, Rothenberger DA, Madoff RD (2001) Clinical rather than laboratory assessment predicts continence after anterior sphincteroplasty. Dis Colon Rectum 44(9):1255–1260 (PMID: 11584195)

    Article  CAS  Google Scholar 

  13. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97 (PMID: 8416784)

    Article  CAS  Google Scholar 

  14. Nevler A (2014) The epidemiology of anal incontinence and symptom severity scoring. Gastroenterol Rep 2(2):79–84. https://doi.org/10.1093/gastro/gou005

    Article  Google Scholar 

  15. Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, Stankiewicz A, Bartram C (2011) State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol 37(4):381–396. https://doi.org/10.1002/uog.8816

    Article  CAS  PubMed  Google Scholar 

  16. Brusciano L, Limongelli P, del Genio G, Sansone S, Rossetti G, Maffettone V, Napoletano V, Sagnelli C, Amoroso A, Russo G, Pizza F, Del Genio A (2007) A useful parameters helping proctologists to identify patients with defaecatory disorders that may be treated with pelvic floor rehabilitation. Tech Coloproctol 11:45–50. https://doi.org/10.1007/s10151-007-0324-3

    Article  CAS  PubMed  Google Scholar 

  17. Brusciano L, Limongelli P, del Genio G, Rossetti G, Sansone S, Healey A, Maffettone V, Napolitano V, Pizza F, Tolone S, del Genio A (2009) Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders. Int J Colorectal Dis 24:961–967. https://doi.org/10.1007/s00384-009-0678-2

    Article  CAS  PubMed  Google Scholar 

  18. Gurland B, Hull T (2008) Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clin Colon Rectal Surg 21(3):157–166. https://doi.org/10.1055/s-2008-1080995

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wadhwa V, Hamid AS, Kumar Y, Scott KM, Chhabra A (2017) Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation. Acta Radiol 58(6):726–733. https://doi.org/10.1177/0284185116668213

    Article  PubMed  Google Scholar 

  20. Meyer I, Richter HE (2014) An evidence-based approach to the evaluation, diagnostic assessment and treatment of fecal incontinence in women. Curr Obstet Gynecol Rep 3(3):155–164. https://doi.org/10.1007/s13669-014-0085-8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Italian Society of Colorectal Surgery (SICCR), Pucciani F, Altomare DF, Dodi G, Falletto E, Frasson A, Giani I, Martellucci J, Naldini G, Piloni V, Sciaudone G, Italian Association of Hospital Gastroenterologists (AIGO), Bove A, Bocchini R, Bellini M, Alduini P, Battaglia E, Galeazzi F, Rossitti P, Usai Satta P (2015) Diagnosis and treatment of faecal incontinence: consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists. Dig Liver Dis 47(8):628–645. https://doi.org/10.1016/j.dld.2015.03.028

    Article  Google Scholar 

  22. Ricciardi R, Mellgren AF, Madoff RD, Baxter NN, Karulf RE, Parker SC (2006) The utility of pudendal nerve terminal motor latencies in idiopathic incontinence. Dis Colon Rectum 49(6):852–857. https://doi.org/10.1007/s10350-006-0529-y

    Article  PubMed  Google Scholar 

  23. Barisić G, Krivokapić Z, Marković V, Popović M, Saranović D, Marsavelska A (2000) The role of overlapping sphincteroplasty in traumatic fecal incontinence. Acta Chir Iugosl 47(4 Suppl 1):37–41 (PMID: 11432241)

    PubMed  Google Scholar 

  24. Bianchi F, Squintani GM, Osio M, Morini A, Bana C, Ardolino G, Barbieri S, Bertolasi L, Caramelli R, Cogiamanian F, Currà A, de Scisciolo G, Foresti C, Frasca V, Frasson E, Inghilleri M, Maderna L, Motti L, Onesti E, Romano MC, Del Carro U (2017) Neurophysiology of the pelvic floor in clinical practice: a systematic literature review. Funct Neurol 22(4):173–193 (PMID: 29306355)

    Article  Google Scholar 

  25. Martellucci J, Naldini G (2011) Clinical relevance of transperineal ultrasound compared with evacuation proctography for the evaluation of patients with obstructed defaecation. Colorectal Dis 13(10):1167–1172. https://doi.org/10.1111/j.1463-1318.2010.02427.x

    Article  CAS  PubMed  Google Scholar 

  26. Martellucci J, Brusciano L (2016) The dynamic transperineal ultrasound era of the evaluation of obstructed defecation syndrome. Dis Colon Rectum 59(8):800–803. https://doi.org/10.1097/DCR.0000000000000586

    Article  PubMed  Google Scholar 

  27. Brusciano L, Limongelli P, Pescatori M, Napolitano V, Gagliardi G, Maffettone V, Rossetti G, del Genio G, Russo G, Pizza F, del Genio A (2007) Ultrasonographic patterns in patients with obstructed defaecation. Int J Colorectal Dis 22:969–997. https://doi.org/10.1007/s00384-006-0250-2

    Article  CAS  PubMed  Google Scholar 

  28. Alexander AA, Miller LS, Liu JB, Feld RI, Goldberg BB (1994) High-resolution endoluminal sonography of the anal sphincter complex. J Ultrasound Med 13(4):281–284 (PMID: 7932992)

    Article  CAS  Google Scholar 

  29. Schäfer A, Enck P, Fürst G, Kahn T, Frieling T, Lübke HJ (1994) Anatomy of the anal sphincters. Comparison of anal endosonography to magnetic resonance imaging. Dis Colon Rectum 37(8):777–781 (PMID: 8055722)

    Article  Google Scholar 

  30. van Gruting IMA, Kluivers K, Sultan AH, De Bin R, Stankiewicz A, Blake H, Thakar R (2018) Does 4D transperineal ultrasound have additional value over 2D transperineal ultrasound for diagnosing posterior pelvic floor disorders in women with obstructed defecation syndrome? Ultrasound Obstet Gynecol 52(6):784–791. https://doi.org/10.1002/uog.19105

    Article  PubMed  Google Scholar 

  31. Hainsworth AJ, Pilkington SA, Grierson C, Rutherford E, Schizas AM, Nugent KP, Williams AB (2016) Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction. Br J Radiol 89(1068):20160522. https://doi.org/10.1259/bjr.20160522(Epub 12 Oct 2016)

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

N/A.

Funding

All authors have no source of funding.

Author information

Authors and Affiliations

  1. Division of General, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli” Naples, via Luigi Pansini n° 5, 80131, Naples, Italy

    Luigi Brusciano, Claudio Gambardella, Salvatore Tolone, Roberto Maria Romano, Francesco Tuccillo, Gianmattia del Genio, Gianmattia Terracciano, Giorgia Gualtieri & Ludovico Docimo

  2. Department of Cardiothoracic Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Claudio Gambardella

  3. Proctology Unit, Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Medical School, 4 Rue Gabrielle-Perret-Gentil, Geneva 14, 1211, Geneva, Switzerland

    Bruno Roche

Authors
  1. Luigi Brusciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio Gambardella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bruno Roche
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Salvatore Tolone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Maria Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Tuccillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gianmattia del Genio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gianmattia Terracciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giorgia Gualtieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ludovico Docimo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed significantly to the present research and reviewed the entire manuscript. LB, CG, and LD: Participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data; also participated substantially in the drafting and editing of the manuscript. BR, ST, RR, FT, GdG, GT, and GG: Participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data. All Authors have read and approve the final manuscript.

Corresponding author

Correspondence to Claudio Gambardella.

Ethics declarations

Conflict of interest

All authors have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brusciano, L., Gambardella, C., Roche, B. et al. Dynamic transperineal ultrasonography correlates with prolonged pudendal nerve latency in female with fecal incontinence. Updates Surg 72, 1187–1194 (2020). https://doi.org/10.1007/s13304-020-00838-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00838-y

Keywords

Search

Navigation