A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation, a comparison with defecography

Murad-Regadas, Sthela M.; Regadas, Francisco Sérgio Pinheiro; Rodrigues, Lusmar Veras; Silva, Flavio R.; Soares, Fábio Alves; Escalante, Rodrigo Dornfeld

doi:10.1007/s00464-007-9532-1

Cited by 71 publications

(92 citation statements)

References 16 publications

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“…Brusciano et al (7) used 2-D endosonography to identify anismus in patients with obstructed defecation and concluded that during straining differences of less than 0.5 cm between the internal border of the PR and the transducer are suggestive of anismus. Murad-Regadas et al (22) developed the 3D-DAUS technique to evaluate the movement of the PR muscle during straining and found the technique to be in almost perfect agreement with defecography. 3D-DAUS may also conveniently be used to identify anorectal dysfunctions such as rectocele, intussusception and enterocele (20,22) .…”

Section: Discussionmentioning

confidence: 99%

“…Murad-Regadas et al (22) developed the 3D-DAUS technique to evaluate the movement of the PR muscle during straining and found the technique to be in almost perfect agreement with defecography. 3D-DAUS may also conveniently be used to identify anorectal dysfunctions such as rectocele, intussusception and enterocele (20,22) .…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Echodefecography (EDF) is a relatively new technique for evaluating posterior compartment prolapse [18]. It is a 3D dynamic anorectal ultrasound modality performed with the same 360°rotating transducer used for EAUS.…”

mentioning

confidence: 99%

Imaging the pelvic floor

Santoro

2017

Tech Coloproctol

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Urinary and fecal incontinence, obstructed defecation, pelvic pain and pelvic organ prolapse are common in older multiparous women, affecting approximately 16% of females aged 40-56 years [1]. As we evaluate a patient with a clinically evident anatomic defect (rectocele, rectal prolapse, perineal descent), it is essential to establish whether this defect is really associated with the patient's symptoms (obstructed defecation). Moreover, a pelvic floor disorder in one compartment frequently coexists with disorders involving other compartments. Indeed, rather than considering the pelvic floor as divided into three vertical compartments, the current concept is to approach the pelvic floor as a horizontal structure [1]. The pelvic floor is a three-dimensional mechanical apparatus that acts as a unit, with a close interrelationship between organ systems, fascia and ligaments, muscles, vessels and nerves. Because the levator ani muscle provides support to all three organ systems, its weakness will result in impaired function of any, or all, of the structures that the muscle supports. In addition, damage to the endopelvic, pubocervical or rectovaginal fascias will lead to herniation of one organ system into another. This is demonstrated by the common coexistence of prolapse of the anterior and posterior vaginal walls requiring repair of both. Understanding pelvic floor anatomy is therefore crucial for an effective management of these dysfunctions.A careful preoperative evaluation is key to determining the pathophysiology of pelvic floor dysfunction [2]. Clinical examination, however, is not accurate in diagnosing anatomical defects of the posterior vaginal wall, overestimating the presence of rectocele (large false-positive rate) but missing enterocele or intussusception in patients with primary pelvic organ prolapse (large false-negative rate) [3,4]. Imaging allows the clinician to better evaluate the patients in order to determine what anatomical alterations are present, and this leads to appropriate surgical interventions and increased success rates [5]. Traditional evacuation proctography or colpocystoproctography, modern dynamic magnetic resonance imaging and ultrasound can be used for visualization of the pelvic floor [5]. Advantages of ultrasound over the other imaging modalities are that it is more widely available, more cost-effective, less time-consuming, and associated with better patient compliance. It is performed by the clinician during office consultation and can be considered as an extension of the physical examination. The development of new technological innovations such as three-/four-dimensional (3D/4D) tools, video-recording, post-processing analysis and the standardization of methodology and terminology [6] have made ultrasound imaging more reproducible and less operator dependent.Several ultrasound techniques can be used to assess the pelvic floor [6]. Translabial ultrasound (TLUS) is performed with the patient placed in the dorsal lithotomy position, with hips flexed and abducted, by using a con...

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Imaging modalities for the detection of posterior compartment disorders in women with obstructed defaecation syndrome

Gruting

Stankiewicz

Thakar

et al. 2015

Cochrane Database of Systematic Reviews

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A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation, a comparison with defecography

Cited by 71 publications

References 16 publications

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

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

Imaging the pelvic floor

Imaging modalities for the detection of posterior compartment disorders in women with obstructed defaecation syndrome

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