1
|
Ralston C, Reena M, Solanki D, Morris S, Schizas AMP, Williams AB, Hainsworth AJ. Can we use integrated total pelvic floor ultrasound as a screening tool in defaecatory pelvic floor dysfunction? A prospective evaluation of the accuracy of integrated total pelvic floor ultrasound compared with defaecation proctography. Colorectal Dis 2025; 27:e17274. [PMID: 39948825 DOI: 10.1111/codi.17274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 09/26/2024] [Accepted: 10/22/2024] [Indexed: 05/09/2025]
Abstract
AIM Pelvic floor dysfunction is common and includes symptoms such as urinary incontinence, pelvic pain, faecal incontinence, obstructive defaecation syndrome symptoms and pelvic organ prolapse. It is investigated with defaecation proctography (DP) and integrated total pelvic floor ultrasound (TPFUS). Whilst DP is currently the gold standard, TPFUS is efficient and less invasive, offering additional sphincter function assessment. This study aimed to compare TPFUS accuracy to DP in the evaluation of pelvic floor dysfunction. METHODS From 2015 to 2016, a prospective observational study was conducted at Guy's and St Thomas's Foundation Trust. Symptomatic women with incomplete evacuation were consecutively invited to participate. Patients underwent three scans using both TPFUS and DP. Reports were independently verified by a blinded consultant. Sensitivity, specificity and agreement were calculated for anatomical (rectocele, intussusception, enterocele, cystocele) and functional (coordination, evacuation) features. RESULTS A total of 216 patients were included. Moderate agreement was seen between DP and TPFUS in prediction of rectoceles (positive predictive value 85%, negative predictive value 67%, Cohen's kappa 0.46) and on the evaluation of dimensions of rectoceles (R coefficient 0.55) (P < 0.0001). Fair agreement was seen in the assessment of propulsion (positive predictive value 76%, negative predictive value 50%, Cohen's kappa 0.25). Poor agreement was observed on other anatomical and functional objectives. CONCLUSION This is the most extensive prospective comparison of these imaging modalities. While there is limited correlation between DP and TPFUS in exploring anatomical and functional aspects of pelvic floor disorders, TPFUS proves to be an effective screening tool. With enhanced expertise and confidence in its use, TPFUS could potentially guide surgical planning rather than solely identifying those needing DP.
Collapse
Affiliation(s)
| | - Max Reena
- Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Deepa Solanki
- Guy's and St Thomas's NHS Foundation Trust, London, UK
| | | | | | | | | |
Collapse
|
2
|
[Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines]. Prog Urol 2017; 26 Suppl 1:S8-S26. [PMID: 27595629 DOI: 10.1016/s1166-7087(16)30425-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique? MATERIAL AND METHODS This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]). RESULTS It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology. CONCLUSION Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
Collapse
|
3
|
Hainsworth AJ, Solanki D, Hamad A, Morris SJ, Schizas AMP, Williams AB. Integrated total pelvic floor ultrasound in pelvic floor defaecatory dysfunction. Colorectal Dis 2017; 19:O54-O65. [PMID: 27886434 DOI: 10.1111/codi.13568] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/30/2016] [Indexed: 02/08/2023]
Abstract
AIM Imaging for pelvic floor defaecatory dysfunction includes defaecation proctography. Integrated total pelvic floor ultrasound (transvaginal, transperineal, endoanal) may be an alternative. This study assesses ultrasound accuracy for the detection of rectocele, intussusception, enterocele and dyssynergy compared with defaecation proctography, and determines if ultrasound can predict symptoms and findings on proctography. Treatment is examined. METHOD Images of 323 women who underwent integrated total pelvic floor ultrasound and defaecation proctography between 2011 and 2014 were blindly reviewed. The size and grade of rectocele, enterocele, intussusception and dyssynergy were noted on both, using proctography as the gold standard. Barium trapping in a rectocele or a functionally significant enterocele was noted on proctography. Demographics and Obstructive Defaecation Symptom scores were collated. RESULTS The positive predictive value of ultrasound was 73% for rectocele, 79% for intussusception and 91% for enterocele. The negative predictive value for dyssynergy was 99%. Agreement was moderate for rectocele and intussusception, good for enterocele and fair for dyssynergy. The majority of rectoceles that required surgery (59/61) and caused barium trapping (85/89) were detected on ultrasound. A rectocele seen on both transvaginal and transperineal scanning was more likely to require surgery than if seen with only one mode (P = 0.0001). If there was intussusception on ultrasound the patient was more likely to have surgery (P = 0.03). An enterocele visualized on ultrasound was likely to be functionally significant on proctography (P = 0.02). There was, however, no association between findings on imaging and symptoms. CONCLUSION Integrated total pelvic floor ultrasound provides a useful screening tool for women with defaecatory dysfunction such that defaecatory imaging can avoided in some.
Collapse
Affiliation(s)
- A J Hainsworth
- The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK
| | - D Solanki
- The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK
| | - A Hamad
- The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK
| | - S J Morris
- The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK
| | - A M P Schizas
- The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK
| | - A B Williams
- The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK
| |
Collapse
|
4
|
Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology. World J Radiol 2016; 8:370-377. [PMID: 27158423 PMCID: PMC4840194 DOI: 10.4329/wjr.v8.i4.370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 01/23/2016] [Accepted: 03/04/2016] [Indexed: 02/06/2023] Open
Abstract
Transperineal ultrasound is an inexpensive, safe and painless technique that dynamically and non-invasively evaluates the anorectal area. It has multiple indications, mainly in urology, gynaecology, surgery and gastroenterology, with increased use in the last decade. It is performed with conventional probes, positioned directly above the anus, and may capture images of the anal canal, rectum, puborectalis muscle (posterior compartment), vagina, uterus, (central compartment), urethra and urinary bladder (anterior compartment). Evacuatory disorders and pelvic floor dysfunction, like rectoceles, enteroceles, rectoanal intussusception, pelvic floor dyssynergy can be diagnosed using this technique. It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature, with images obtained at rest, straining and sustained squeezing. This technique is an accurate examination for detecting, classifying and following of perianal inflammatory disease. It can also be used to sonographically guide drainage of deep pelvic abscesses, mainly in patients who cannot undergo conventional drainage. Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence, postpartum and also following surgical repair of obstetric tears. There are also some studies referring to its role in anal stenosis, for the measurement of the anal cushions in haemorrhoids and in chronic anal pain.
Collapse
|
5
|
Parsy C, Cosson M, Quinton JF, Laurent N, Lucot JP, Tempremant F, Poncelet E. Mise au point sur l’hédrocèle, un trouble de la statique pelvienne méconnu. ACTA ACUST UNITED AC 2015; 43:459-64. [DOI: 10.1016/j.gyobfe.2015.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
|
6
|
Faucheron JL, Barot S, Collomb D, Hohn N, Anglade D, Dubreuil A. Dynamic cystocolpoproctography is superior to functional pelvic MRI in the diagnosis of posterior pelvic floor disorders: results of a prospective study. Colorectal Dis 2014; 16:O240-7. [PMID: 24506228 DOI: 10.1111/codi.12586] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/02/2013] [Indexed: 02/08/2023]
Abstract
AIM The accuracy of dynamic cystocolpoproctography (DCP) and dynamic MRI were compared in diagnosing posterior pelvic floor disorders. METHOD Fifty consecutive female patients (mean age 51 years) complaining of posterior compartment pelvic floor disorder and referred to a tertiary centre entered the prospective study. The Institutional Review Board stated that informed consent from the patients was not necessary for this study. Patients underwent a DCP and a supine functional MRI by two different radiologists. Assessment of radiological examinations was prospective and blind. All patients underwent surgery that led to the final diagnosis. Agreement between the operative diagnosis and the diagnoses following DCP and MRI was assessed using the weighted kappa statistic. A matched-pairs McNemar's test was applied to demonstrate whether or not one radiological method was superior to the other. RESULTS Full-thickness rectal prolapse was best diagnosed by clinical examination. Internal rectal prolapse and peritoneocele were best diagnosed by DCP. A better agreement with the operative diagnosis, which is not true superiority, was observed for DCP compared with functional pelvic MRI for full-thickness rectal prolapse, internal rectal prolapse and peritoneocele. There was no significant difference between DCP and functional pelvic MRI in the diagnosis of internal rectal prolapse (P = 0.125) or peritoneocele (P = 0.10). CONCLUSION As full-thickness rectal prolapse, internal rectal prolapse and peritoneocele might be missed by functional pelvic MRI, there should still be a place for DCP in particular cases where the clinical diagnosis is not clear in women with symptomatic posterior pelvic floor disorders.
Collapse
Affiliation(s)
- J-L Faucheron
- Colorectal Unit, Department of Surgery, Grenoble University Hospital, Grenoble, France
| | | | | | | | | | | |
Collapse
|
7
|
STEWARD MJ, TAYLOR SA, BRUNELL C. Advances in MRI assessment of pelvic floor structure and function: a review. IMAGING 2013. [DOI: 10.1259/imaging.20100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
8
|
Maccioni F. Functional disorders of the ano-rectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI. ACTA ACUST UNITED AC 2012; 38:930-51. [DOI: 10.1007/s00261-012-9955-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
9
|
Martellucci J, Naldini G. Clinical relevance of transperineal ultrasound compared with evacuation proctography for the evaluation of patients with obstructed defaecation. Colorectal Dis 2011; 13:1167-1172. [PMID: 20860722 DOI: 10.1111/j.1463-1318.2010.02427.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Dynamic evacuation proctography (DEP) is still considered the gold standard diagnostic procedure for posterior compartment pelvic disorders. The study aimed to assess the value of dynamic transperineal ultrasound (DTPU) compared with DEP in patients with obstructed defaecation syndrome (ODS). METHOD In a prospective observational study, 54 consecutive female patients referred with symptoms of ODS between January and June 2009 were studied by clinical evaluation (including Wexner score), perineal ultrasound and defaecography. The tests were analysed by two experienced investigators unaware of the opinion of the other. RESULTS DEP revealed a rectocoele in 35 (64%), intussusception in 27 (50%) and enterocoele in 10 (18.5%) patients. DTPU revealed a rectocoele in 32 (59%), intussusception in 23 (42%) and enterocoele in 11 (20%) patients. The degree of agreement of the two techniques calculated using the Cohen kappa method was 0.69 for rectocoele, 0.74 for intussusception and 0.86 for enterocoele. In patients with grade 2-3 rectocoele, the agreement was 0.88. There was no significant difference between the two techniques in the measurement of the anorectal angle or in the detection of dyssynergic contraction of the puborectalis. DTPU was better at identifying multiple diagnoses and associated pelvic floor alterations. CONCLUSION The degree of concordance between the two techniques is good. DTPU is accurate for asymptomatic patients with ODS and can be considered an alternative to DEP in the assessment of such patients.
Collapse
Affiliation(s)
- J Martellucci
- General Surgery I, University of Siena, Siena, Italy.
| | | |
Collapse
|
10
|
Maglinte DDT, Bartram CI, Hale DA, Park J, Kohli MD, Robb BW, Romano S, Lappas JC. Functional imaging of the pelvic floor. Radiology 2011; 258:23-39. [PMID: 21183491 DOI: 10.1148/radiol.10092367] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The clinical treatment of patients with anorectal and pelvic floor dysfunction is often difficult. Dynamic cystocolpoproctography (DCP) has evolved from a method of evaluating the anorectum for functional disorders to its current status as a functional method of evaluating the global pelvic floor for defecatory disorders and pelvic organ prolapse. It has both high observer accuracy and a high yield of positive diagnoses. Clinicians find it a useful diagnostic tool that can alter management decisions from surgical to medical and vice versa in many cases. Functional radiography provides the maximum stress to the pelvic floor, resulting in levator ani relaxation accompanied by rectal emptying-which is needed to diagnose defecatory disorders. It also provides organ-specific quantificative information about female pelvic organ prolapse-information that usually can only be inferred by means of physical examination. The application of functional radiography to the assessment of defecatory disorders and pelvic organ prolapse has highlighted the limitations of physical examination. It has become clear that pelvic floor disorders rarely occur in isolation and that global pelvic floor assessment is necessary. Despite the advances in other imaging methods, DCP has remained a practical, cost-effective procedure for the evaluation of anorectal and pelvic floor dysfunction. In this article, the authors describe the technique they use when performing DCP, define the radiographic criteria used for diagnosis, and discuss the limitations and clinical utility of DCP.
Collapse
Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine, Indiana University Hospital, 550 N University Blvd, UH0279, Indianapolis, IN 46202-5253, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR Am J Roentgenol 2010; 194:1640-9. [PMID: 20489108 DOI: 10.2214/ajr.09.3670] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this article is to review the relevant anatomy and sonographic, fluoroscopic, and MRI options for evaluating patients with pelvic floor disorders. CONCLUSION Disorders of the pelvic floor are a heterogeneous and complex group of problems. Imaging can help elucidate the presence and extent of pelvic floor abnormalities. MRI is particularly well suited for global pelvic floor assessment including pelvic organ prolapse, defecatory function, and pelvic floor support structure integrity.
Collapse
|
12
|
Lapray JF, Costa P, Delmas V, Haab F. Rôle de l’imagerie dans l’exploration des troubles de la statique pelvienne. Prog Urol 2009; 19:953-69. [DOI: 10.1016/j.purol.2009.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
|
13
|
Abstract
Pelvic floor function and structure are complex, and imaging (integrated with an understanding of physiology) is central to guiding the clinician in managing patients with incontinence, constipation, difficult rectal evacuation and pelvic organ prolapse. Multimodal imaging techniques such as static and dynamic imaging techniques (sometimes combined in a single sitting) have revolutionised our understanding of functional anatomy. The advent of endo-luminal imaging has increased our spatial resolution by its closer proximity to the area of interest. Dynamic imaging gives us a near physiological data set which helps us to simulate what is likely to happen in real life and gives us a better understanding of the multifactorial causes, and consequences, of pelvic floor dysfunction.
Collapse
Affiliation(s)
- Stuart A Taylor
- Clinical Radiology, University College London, 235 Euston Road, London NW1 2BU, UK.
| |
Collapse
|
14
|
Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Mayfield Heights, Ohio, USA
| |
Collapse
|
15
|
|
16
|
Grasso RF, Piciucchi S, Quattrocchi CC, Sammarra M, Ripetti V, Zobel BB. Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:86-94. [PMID: 17587218 DOI: 10.1002/uog.4047] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To compare introital ultrasound with colpocystodefecography (CCD) in quantifying the anorectal angle and in the diagnosis of posterior pelvic floor disorders. METHODS Forty-three consecutive women with functional impairment of the posterior pelvic floor were enrolled after a clinical evaluation. Using both CCD and introital ultrasound examination, the anorectal angle was measured during squeezing to evaluate the strength of voluntary muscle contraction and during straining to assess pelvic floor relaxation. Rectocele depth and the presence of intussusception were assessed. The performance of CCD and that of introital ultrasound were compared. RESULTS Good concordance was obtained between introital ultrasound and CCD. The intraclass correlation coefficient was 0.82 (95% CI, 0.69-0.89) for measurement of the anorectal angle during squeezing and 0.67 (95% CI, 0.47-0.81) during straining. Rectoceles > 4 cm on CCD were detected by introital ultrasound in 100% of cases, and there was 91% agreement for rectal intussusception. Cohen's kappa index was moderate for rectocele assessment (0.41, P < 0.01) and excellent for intussusception (0.91, P < 0.001). It was also noted that introital ultrasound could be used to detect pelvic floor dyssynergia. CONCLUSIONS Introital ultrasound is a simple, accurate, non-invasive method with which to assess anorectal dynamics.
Collapse
Affiliation(s)
- R F Grasso
- Interdisciplinary Center for Biomedical Research, Department of Radiology, University Campus Bio-Medico, Rome, Italy
| | | | | | | | | | | |
Collapse
|
17
|
Collins SA, Jelovsek JE, Chen CCG, Gustilo-Ashby AM, Barber MD. De novo rectal prolapse after obliterative and reconstructive vaginal surgery for urogenital prolapse. Am J Obstet Gynecol 2007; 197:84.e1-3. [PMID: 17618769 DOI: 10.1016/j.ajog.2007.02.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 01/06/2007] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the incidence of de novo rectal prolapse after obliterative vaginal surgery with the incidence that was seen after reconstructive vaginal surgery for urogenital prolapse. STUDY DESIGN A chart review was performed on subjects who underwent vaginal surgery for urogenital prolapse from Jan. 1, 2001, through Dec. 31, 2004, at the Cleveland Clinic. Diagnosis of postoperative rectal prolapse was identified with ICD-9 code 569.1. RESULTS Nine hundred sixteen women underwent vaginal surgery for urogenital prolapse. Ninety-two percent of the women (n = 840) underwent reconstructive surgery, and 8% of the women (n = 76) underwent obliterative surgery. The incidence of postoperative full-thickness rectal prolapse in women who were > or = 65 years old who underwent obliterative surgery was 3 of 74 (4.1%; 95% CI, 1.4-11), with an estimated odds ratio of 22 (95% CI, 2.3-196; P < .002) compared with women who were > or = 65 years old who underwent reconstructive surgery. CONCLUSION Obliterative surgery is associated with a substantially greater risk of de novo rectal prolapse than reconstructive vaginal surgery for urogenital prolapse.
Collapse
Affiliation(s)
- Sarah A Collins
- Section of Urogynecology and Reconstructive Pelvic Surgery, Division of Surgery, Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | | |
Collapse
|
18
|
Maglinte DDT, Bartram C. Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: techniques, indications, results and limitations. Eur J Radiol 2006; 61:454-61. [PMID: 17161573 DOI: 10.1016/j.ejrad.2006.07.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 07/26/2006] [Indexed: 11/24/2022]
Abstract
The clinical management of patients with anorectal and pelvic floor dysfunction is often difficult. Evacuation proctography has evolved from a method to evaluate the anorectum for functional disorders to its current status as a practical method for evaluating anorectal dysfunction and pelvic floor prolapse. It has a high observer accuracy and yield of positive diagnosis. Clinicians find it of major benefit and has altered management from surgical to medical and vice versa in a significant number of cases.
Collapse
Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University Medical Center, University Hospital and Outpatient Center, 550 N. University Blvd. UH 0279, Indianapolis, IN 46202, USA.
| | | |
Collapse
|
19
|
Reply. AJR Am J Roentgenol 2006. [DOI: 10.2214/ajr.06.5038.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
20
|
Dobben AC, Wiersma TG, Janssen LWM, de Vos R, Terra MP, Baeten CG, Stoker J. Prospective Assessment of Interobserver Agreement for Defecography in Fecal Incontinence. AJR Am J Roentgenol 2005; 185:1166-72. [PMID: 16247127 DOI: 10.2214/ajr.04.1387] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The primary aim of our study was to determine the interobserver agreement of defecography in diagnosing enterocele, anterior rectocele, intussusception, and anismus in fecal-incontinent patients. The subsidiary aim was to evaluate the influence of level of experience on interpreting defecography. SUBJECTS AND METHODS Defecography was performed in 105 consecutive fecal-incontinent patients. Observers were classified by level of experience and their findings were compared with the findings of an expert radiologist. The quality of the expert radiologist's findings was evaluated by an intraobserver agreement procedure. RESULTS Intraobserver agreement was good to very good except for anismus: incomplete evacuation after 30 sec (kappa, 0.55) and puborectalis impression (kappa, 0.54). Interobserver agreement for enterocele and rectocele was good (kappa, 0.66 for both) and for intussusception, fair (kappa, 0.29). Interobserver agreement for anismus: incomplete evacuation after 30 sec was moderate (kappa, 0.47), and for anismus: puborectalis impression was fair (kappa, 0.24). Agreement in grading of enterocele and rectocele was good (kappa, 0.64 and 0.72, respectively) and for intussusception, fair (kappa, 0.39). Agreement separated by experience level was very good for rectocele (kappa, 0.83) and grading of rectoceles (kappa, 0.83) and moderate for intussusception (kappa, 0.44) at the most experienced level. For enterocele and grading, experience level did not influence the reproducibility. CONCLUSION Reproducibility for enterocele, anterior rectocele, and severity grading is good, but for intussusception is fair to moderate. For anismus, the diagnosis of incomplete evacuation after 30 sec is more reproducible than puborectalis impression. The level of experience seems to play a role in diagnosing anterior rectocele and its grading and in diagnosing intussusception.
Collapse
Affiliation(s)
- Annette C Dobben
- Department of Radiology, G1-228, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
21
|
Cundiff GW, Fenner D. Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol 2005; 104:1403-21. [PMID: 15572506 DOI: 10.1097/01.aog.0000147598.50638.15] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pelvic organ prolapse is a common and growing condition for which women seek help and frequently undergo surgical management. Prolapse of the posterior vaginal wall, alone or in combination with other compartment defects, can be a challenge for the pelvic surgeon. A clear understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship or lack of relationship between anatomy and function is required. Vaginal support defects occur with and without symptoms, and many of the symptoms attributed to pelvic organ prolapse can result from other causes. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and fecal incontinence are some of the symptoms that have been correlated with rectoceles. Whether the prolapse is the cause of these symptoms or is a result of straining and stretching of support tissues in women with defecation disorders is still unknown. We will present the current literature on these relationships and what evaluations are useful when caring for a woman with a rectocele and defecation disorders. Either pessaries or surgery can be used for treating rectoceles. Several surgical techniques have been described, including transvaginal, transanal, abdominal, and the use of graft materials to treat both anatomical defects and functional symptoms. The success, rationale, and complications of each approach, including anatomic cure, impact on defecation, and sexual function, are presented.
Collapse
Affiliation(s)
- Geoffrey W Cundiff
- Johns Hopkins Medicine, Baltimore, Maryland; and University of Michigan, Ann Arbor, Michigan, USA.
| | | |
Collapse
|
22
|
|