A novel procedure to assess anismus using three‐dimensional dynamic anal ultrasonography

Murad-Regadas, Sthela M.; Regadas, Francisco Sérgio Pinheiro; Rodrigues, Lusmar Veras; Souza, Marcellus H.; Lima, Doryane Maria dos Reis; Silva, F. R. S.; Filho, Francisco L. de Caldas

doi:10.1111/j.1463-1318.2006.01157.x

Cited by 34 publications

(37 citation statements)

References 19 publications

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“…E-mail: smregadas@hospitalsaocarlos.com.br or the middle compartment (entero/sigmoidocele grade III). The technique has been shown to correlate well with conventional defecography and has been validated in a prospective multicenter study (18,19,22) . Proper management of patients with pelvic floor dysfunctions requires extensive knowledge of the specific anatomy and physiopathology involved and, if available, dynamic diagnostic tools.…”

Section: Introductionmentioning

confidence: 99%

“…However, the relation between vaginal delivery, age (post-menopause) and posterior pelvic floor dysfunctions involving obstructed defecation syndrome (ODS) is still a matter of controversy (8,14,17,19,27) . Pelvic floor dysfunctions are best evaluated with dynamic techniques such as magnetic resonance (9,15) and ultrasonography using endorectal (2,18,19) or transperineal (3,7) probes to view the anal canal and pelvis anatomy. Thus, echodefecography, a 3-D dynamic anorectal ultrasonography technique recently developed by Murad-Regadas et al (19) , may be used to evaluate voiding disorders affecting the posterior compartment (rectocele, rectal intussusception, anismus)…”

Section: Introductionmentioning

confidence: 99%

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Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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-Context -The correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. Objectives -To determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. Methods -Four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3D ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade II or III, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade III). In addition, sphincter damage was evaluated. Patients were grouped according to age (≤50y x >50y) and stratified by mode of delivery and parity: group I (≤50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group II (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. Additionally, patients were stratified by number of vaginal deliveries: 0 -nulliparous (n = 135), 1 -vaginal (n = 46), >1 -vaginal (n = 166). Results -Rectocele grade II or III, intussusception, rectocele + intussusception and sphincter damage were more prevalent in Group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001). The stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. Entero/sigmoidocele was more prevalent in the vaginal group ≤50y and in the nulliparous and vaginal groups >50y. No correlation was found between rectocele and the number of vaginal deliveries. Conclusion -Higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. However, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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“…As there is no individual test that can diagnose all aspects of constipation, many innovative ideas continue to surface in the literature, such as three-dimensional dynamic ultrasound, 25,26 scintigraphic defecography, 27 viscous fluid expulsion, 28 or the rectal cooling test. 29 There is still not enough data about these methods to recommend them.…”

Section: Balloon Expulsion Testmentioning

confidence: 99%

Anorectal Physiologic Evaluation of Constipation

Denoya

Sands²

2008

Clinics in Colon and Rectal Surgery

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Chronic constipation is a widespread problem which affects 63 million people in North America alone. Although the majority of patients respond to changes in dietary fiber and water intake, as well as the judicious use of laxatives, a small portion will not and as a result, will be evaluated by gastroenterologists and colorectal surgeons. These patients most frequently have slow transit constipation, pelvic floor dysfunction, or some combination of the two. The physiologic evaluation of these patients comprises colonic transit studies, anorectal manometry, cinedefecography, electromyography, and pudendal nerve terminal motor latency testing. In this article, the authors describe the physiologic basis for these studies and review the techniques used in diagnosing these conditions.

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“…Once identified and quantified, anatomical and functional changes can be correlated with clinical symptoms and proctological findings (6) . Defecography, manometry, electromyography and, more recently, dynamic magnetic resonance scanning and dynamic anorectal ultrasonography, have all been used to diagnose patients with pelvic floor dysfunctions (1,2,3,4,5,6,7,8,9,11,12,13,14,15,16,17,18,19,20,21,22,23,24,26,27,28,29,30) . Advances in ultrasound technology includes the development of the three-dimensional (3D) anorectal transducer and allows to clearly visualize the anatomic configuration of the anal canal in multiplane images (27) but the twodimensional (2D) ultrasound can be useful in the diagnosis of anorectal disease (7,10,24) .…”

Section: Introductionmentioning

confidence: 99%

“…It is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles (25) . Dynamic endosonography has become an important diagnostic tool in anismus patients as it allows to visualize the anal sphincters both at rest and during straining (1,2,7,20,21,22,23,24,29) . Recently, Murad-Regadas et al (23) described a novel technique for the assessment of anismus using dynamic two-dimensional anal ultrasonography (2D-DAUS) with satisfactory results when compared to dynamic threedimensional anal ultrasonography (3D-DAUS).…”

Section: Introductionmentioning

confidence: 99%

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

Murad-Regadas

Regadas

Barreto³

et al. 2010

Arq. Gastroenterol.

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-Context -Anismus is a prevalent functional cause of outlet delay. It is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles. Objective -To evaluate the ability of two dimensional anal ultrasonography to identify anismus patients with paradoxical contraction or normal relaxation, comparing findings with manometric measurements. Methods -Forty-nine women presenting with outlet delay and a mean validated Wexner constipation score of 13.5 were included in a prospective study. Following screening with anal manometry, the patients were assigned to one of two groups: G-I -with normal relaxation and G-II -patients with anismus. Dynamic anorectal ultrasonography was used to quantifier the movement of the puborectalis muscle and to measure changes in the angle between two converging lines drawn from the 3 o'clock and the 9 o'clock positions of the endoprobe circumference to the internal border of the puborectalis muscle. The angle decreases during straining in patients with normal relaxation, but increases in patients with anismus. The agreement between the two techniques was verified with the Kappa index. Results -In manometry, during straining the anal canal pressure decreased by 41.3% in G-I and increased by 168.6% in G-II, indicating a diagnosis of anismus for the second group. In US, during straining, the angle produced by the movement of the puborectalis muscle decreased from 63 ± 1.31 to 58 ± 1.509 degrees (P = 0.0135) in 23 of the 30 patients in G-I, indicating normal relaxation, and increased from 66 ± 0.972 to 72 ± 0.897 degrees (P = 0.0001) in 16 of the 19 patients in G-II, indicating anismus. The index of agreement between manometry and two dimensional anal ultrasonography was moderate: 77% (23/30) for G-I and 84% (16/19) for G-II. Conclusion -Two-dimensional dynamic anal ultrasonography showed similar results previously suggested by anal manometry at identifying patients with normal relaxation or paradoxical contraction.

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A novel procedure to assess anismus using three‐dimensional dynamic anal ultrasonography

Abstract: Three-dimensional endosonography is a useful method to assess patients with anismus confirming the anorectal manometric results.

Cited by 34 publications

References 19 publications

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Anorectal Physiologic Evaluation of Constipation

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

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