A novel two‐dimensional dynamic anal ultrasonography technique to assess anismus comparing with three‐dimensional echodefecography

Murad-Regadas, Sthela Maria; Regadas, Francisco Sérgio Pinheiro; Barreto, Rosilma Gorete Lima; Rodrigues, Lusmar Veras; Souza, Marcellus H.

doi:10.1111/j.1463-1318.2009.02018.x

Cited by 10 publications

(11 citation statements)

References 10 publications

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“…Recently, Murad-Regadas et al (23) described a novel technique for the assessment of anismus using 2D-DAUS with satisfactory results and substantial agreement with 3D-DAUS findings. In the present study, 2D-DAUS agreed moderately with anorectal manometry, identifying 23 of 30 patients with normal relaxation and 16 of 19 patients with anismus.…”

Section: Discussionmentioning

confidence: 99%

“…The movement of the PR muscle was quantified by measuring 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 6 o'clock position on the internal border of the PR muscle. The angle decreases at least 1° during straining in patients with normal relaxation, but increases at least 1° in patients with anismus (23) . The same patient should be compared at rest with straining.…”

Section: Dynamic Anal Ultrasonographymentioning

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%

“…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). The purpose of this prospective study was to evaluate the ability of 2D-DAUS to identify patients with paradoxical contraction (anismus) or normal relaxation, comparing with manometric findings.…”

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: Dynamic Anal Ultrasonographymentioning

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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“…The increase in puborectalis angle between the resting and straining is > 1° in normal individuals. Less than 1° increase indicates paradoxical contraction of PR, which is a clinically significant sign for the diagnosis of animus[14]. …”

Section: Methodsmentioning

confidence: 99%

Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

Xue

Ding

et al. 2017

WJG

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AIMTo assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP).METHODSIn this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups.RESULTSPatients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 ± 3.59 mm vs 28.87 ± 4.84 mm, P < 0.05 and 9.67 ± 1.57 mm vs 8.85 ± 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23° ± 1.81° vs 89.94° ± 2.07° in control group, P < 0.05) and straining (88.47° ± 3.32° vs 90.72° ± 1.87° in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23° ± 1.81° vs 88.47° ± 3.32° respectively, P > 0.05).CONCLUSIONThe association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.

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Pelvic Outlet Obstruction

Davids

2020

Clinical Decision Making in Colorectal Surgery

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A novel two‐dimensional dynamic anal ultrasonography technique to assess anismus comparing with three‐dimensional echodefecography

Abstract: Two-dimensional dynamic anal ultrasonography can be used as an alternative method to assess patients with anismus, although the 3-D modality is more precise to evaluate the PR angle as the sphincters integrity as the whole muscle length is clearly visualized.

Cited by 10 publications

References 10 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

Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

Pelvic Outlet Obstruction

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