Dynamic Transperineal Ultrasound Vs. Defecography in Patients with Evacuatory Difficulty: a Pilot Study

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2003 May 23

PMID 12761642

Citations 31

Authors

M Beer-Gabel

M Teshler

E Schechtman

A P Zbar

Affiliations

Soon will be listed here.

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 degrees as measured by defecography and 116.4+/-3.3 degrees 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.

Citing Articles

A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse.

Nam G, Song J, Lee S Diagnostics (Basel). 2022; 12(1).

PMID: 35054265 PMC: 8775178. DOI: 10.3390/diagnostics12010098.

Is the transperineal ultrasonography approach effective for the diagnosis of rectocele?.

Yao Y, Yin H, Wang H, Liang H, Wang B, Wang C Gastroenterol Rep (Oxf). 2021; 9(5):461-469.

PMID: 34733532 PMC: 8560031. DOI: 10.1093/gastro/goab019.

Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases.

Nam G, Lee S, Kim S, Chae H J Clin Med. 2021; 10(18).

PMID: 34575378 PMC: 8466392. DOI: 10.3390/jcm10184267.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

van Gruting I, Stankiewicz A, Thakar R, Santoro G, IntHout J, Sultan A Cochrane Database Syst Rev. 2021; 9:CD011482.

PMID: 34553773 PMC: 8459393. DOI: 10.1002/14651858.CD011482.pub2.

Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders.

Jeong H, Yang S, Cho D, Park D, Lee J Ann Coloproctol. 2020; 36(4):256-263.

PMID: 32178497 PMC: 7508475. DOI: 10.3393/ac.2020.02.09.

References

Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J . Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging. 1999; 9(3):373-7. DOI: 10.1002/(sici)1522-2586(199903)9:3<373::aid-jmri2>3.0.co;2-h. View

Kleinubing Jr H, Jannini J, Malafaia O, Brenner S, Pinho T . Transperineal ultrasonography: new method to image the anorectal region. Dis Colon Rectum. 2000; 43(11):1572-4. DOI: 10.1007/BF02236741. View

Shorvon P, McHugh S, Diamant N, Somers S, Stevenson G . Defecography in normal volunteers: results and implications. Gut. 1989; 30(12):1737-49. PMC: 1434461. DOI: 10.1136/gut.30.12.1737. View

Schoenenberger A, Debatin J, Guldenschuh I, Hany T, Steiner P, Krestin G . Dynamic MR defecography with a superconducting, open-configuration MR system. Radiology. 1998; 206(3):641-6. DOI: 10.1148/radiology.206.3.9494480. View

Matsuoka H, Wexner S, Desai M, Nakamura T, Nogueras J, Weiss E . A comparison between dynamic pelvic magnetic resonance imaging and videoproctography in patients with constipation. Dis Colon Rectum. 2001; 44(4):571-6. DOI: 10.1007/BF02234331. View

Kelvin F, Maglinte D, Hale D, Benson J . Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol. 2000; 174(1):81-8. DOI: 10.2214/ajr.174.1.1740081. View

Rubens D, Strang J, Wexler I . Transperineal sonography of the rectum: anatomy and pathology revealed by sonography compared with CT and MR imaging. AJR Am J Roentgenol. 1998; 170(3):637-42. DOI: 10.2214/ajr.170.3.9490944. View

Siproudhis L, Ropert A, VILOTTE J, Bretagne J, Heresbach D, Raoul J . 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. 1993; 36(5):430-8. DOI: 10.1007/BF02050007. View

Felt-Bersma R, Luth W, Janssen J, Meuwissen S . Defecography in patients with anorectal disorders. Which findings are clinically relevant?. Dis Colon Rectum. 1990; 33(4):277-84. DOI: 10.1007/BF02055468. View

10.

Peschers U, DeLancey J, Schaer G, Schuessler B . Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol. 1997; 104(9):999-1003. DOI: 10.1111/j.1471-0528.1997.tb12056.x. View

11.

Knowles C, Eccersley A, Scott S, Walker S, REEVES B, Lunniss P . Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Dis Colon Rectum. 2000; 43(10):1419-26. DOI: 10.1007/BF02236639. View

12.

Beer-Gabel M, Teshler M, Barzilai N, Lurie Y, Malnick S, Bass D . Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders: pilot study. Dis Colon Rectum. 2002; 45(2):239-45; discussion 245-8. DOI: 10.1007/s10350-004-6155-7. View

13.

JORGE J, Ger G, Gonzalez L, Wexner S . Patient position during cinedefecography. Influence on perineal descent and other measurements. Dis Colon Rectum. 1994; 37(9):927-31. DOI: 10.1007/BF02052600. View

14.

Lienemann A, Anthuber C, Baron A, Kohz P, Reiser M . Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol. 1997; 7(8):1309-17. DOI: 10.1007/s003300050294. View

15.

Pittman J, Benson J, Sumners J . Physiologic evaluation of the anorectum. A new ultrasound technique. Dis Colon Rectum. 1990; 33(6):476-8. DOI: 10.1007/BF02052141. View

16.

Zbar A, Aslam M, Gold D, Gatzen C, Gosling A, Kmiot W . Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation. Dis Colon Rectum. 1998; 41(2):200-8. DOI: 10.1007/BF02238249. View

17.

Mellgren A, Johansson C, Dolk A, Anzen B, Bremmer S, Nilsson B . Enterocele demonstrated by defaecography is associated with other pelvic floor disorders. Int J Colorectal Dis. 1994; 9(3):121-4. DOI: 10.1007/BF00290186. View

18.

Kelvin F, Hale D, Maglinte D, Patten B, Benson J . Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR Am J Roentgenol. 1999; 173(1):31-7. DOI: 10.2214/ajr.173.1.10397095. View

19.

Dietz H, Clarke B . The influence of posture on perineal ultrasound imaging parameters. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12(2):104-6. DOI: 10.1007/pl00004030. View

20.

Low V, Ho L, Freed K . Vaginal opacification during defecography: direction of vaginal migration aids in diagnosis of pelvic floor pathology. Abdom Imaging. 1999; 24(6):565-8. DOI: 10.1007/s002619900564. View