Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity?

Abstract

MR defecography (MRD) is an alternative to conventional defecography (CD) which allows for dynamic visualisation of the pelvic floor. The aim of this study was to assess whether MRI features indicative of pelvic floor dysfunction correlated with patient-reported symptom severity. MR proctograms were matched to a prospectively-maintained functional database. Univariate and multivariate analyses were performed using pre-treatment questionnaire responses to the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score (WIS), and modified Obstructed Defecation Symptom (ODS) Score. 302 MRI proctograms were performed between January 2012 and April 2015. 170 patients were included. Patients with a rectocele > 2 cm (p = 0.003; OR 5.756) or MRD features suggestive of puborectalis syndrome (p = 0.025; OR 8.602) were more likely to report a higher ODS score on multivariate analysis. Lack of rectal evacuation was negatively associated with an abnormal WIS (p = 0.007; OR 0.228). Age > 50 (p = 0.027, OR 2.204) and a history of pelvic floor surgery (p = 0.042, OR 0.359) were correlated with an abnormal BBUSQ incontinence score. Lack of rectal evacuation (p = 0.027, OR 3.602) was associated with an abnormal BBUSQ constipation score. Age > 50 (p = 0.07, OR 0.156) and the presence of rectoanal intussusception (p = 0.010, OR 0.138) were associated with an abnormal BBUSQ evacuation score. Whilst MRD is a useful tool in aiding multidisciplinary decision making, overall, it is poorly correlated with patient-reported symptom severity, and treatment decisions should not rest solely on results.

Does sequential balloon expulsion test improve the screening of defecation disorders?

“…That way it is difficult to reproduce their good results using their score as a screening tool. This goes in line with recent reviews that consider clinical scores useless for screening or diagnostic purposes in DD [24,25]. One possible explanation is that patients, when asked about their symptoms, tend to exaggerate their complains when evoking them retrospectively.…”

Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study

“…Severity of functional symptoms and findings on dMRI are poorly correlated. 28 Focus on functional outcome was therefore another strength. Dichotomized cutoff points for obstructed defecation and fecal incontinence were used.…”

Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer

“…Other exams have been evaluated as dynamic MRI. As this exam is poorly correlated to patient-reported symptom severity (69,70), its place is restricted to patients with an externalized or suspected prolapse.…”