Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons

Paquette, Ian M.; Rosman, David A.; Sayed, El; Hull, Tracy L.; Kocjancic, Ervin; Quiroz, Lieschen H.; Palmer, Susan B.; Shobeiri, Abbas; Weinstein, Milena M.; Khatri, Gaurav; Bordeianou, Liliana

doi:10.1097/spv.0000000000000956

Cited by 5 publications

(14 citation statements)

References 57 publications

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“…A recently published consensus statement on definitions and interpretation of fluoroscopic defecography for pelvic floor disorders recommends standardization of radiologic reporting of rectocele on defecography. They recommend that rectocele seen on defecography should be described as present or absent and subsequently quantified in size (centimeters) instead of severity to avoid interobserver variation 4 . Our study supports this consortium’s statement that radiographic assignment of rectocele severity (ie, small, moderate, large) is not predictive of rectocele stage on physical examination or of subsequent surgical intervention.…”

Section: Discussionsupporting

confidence: 81%

“…Identification of incomplete defecation or retention of contrast has been recommended as a noteworthy component of defecography reports 4 . In our study, retention of contrast within the rectocele was significantly correlated with increased rectocele size on defecography (large vs no rectocele, P = 0.005).…”

Section: Discussionsupporting

confidence: 54%

“…Clinical correlation, including both pelvic organ prolapse and defecatory symptoms along with pelvic examination, is imperative when counseling patients regarding the finding of rectocele on radiologic images. Defecography should not act as a substitute for clinical evaluation by a pelvic floor specialist 4,6 …”

Section: Discussionmentioning

confidence: 99%

“…Imaging modalities, including fluoroscopic defecography, can complement physical examination findings in the evaluation of the pelvic floor and defecatory disorders. While defecography provides a functional evaluation of the small bowel, distal colon, rectum, and other pelvic organs during evacuation, its clinical usefulness is limited by lack of consensus regarding definitions of pathology (ie, rectocele), varying protocols, and contradicting interpretations 4 …”

mentioning

confidence: 99%

“…Imaging, such as dynamic magnetic resonance imaging, has been evaluated in comparison with physical examination, but fluoroscopic defecography has not yet been standardized for the evaluation of pelvic organ prolapse 4,5 . A single-center retrospective review failed to show a correlation between rectocele size on defecography and physical examination 6 …”

mentioning

confidence: 99%

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Rectocele: Correlation Between Defecography and Physical Examination

Crowder

Sayegh

Guaderrama³

et al. 2023

UROGC

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ImportanceThere is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse.ObjectivesThe aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes.Study DesignThis was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable.ResultsOne hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59–11.34; P < 0.01) as was advanced PVWP stage (P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms (P = 0.02).ConclusionsWe demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Rectocele: Correlation Between Defecography and Physical Examination

Crowder

Sayegh

Guaderrama³

et al. 2023

UROGC

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The investigation of posterior compartment disorders: An integrated approach

Gala,

Gadiyar,

Breslin

et al. 2023

Continence

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Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus

Gurland,

Olson,

McCarthy

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: There is wide variation for prolapse care. OBJECTIVE: To determine core descriptor sets for rectal prolapse to enhance outcomes research. DESIGN: Descriptors for patients undergoing rectal prolapse surgery were generated through a systematic review and expert opinion. Stakeholders were recruited internationally via list-serve and social media. Experts were encouraged to consider the minimum descriptors that could be considered during clinical care, and descriptors were grouped into core descriptor sets. Consensus was defined as > 70% agreement. SETTING: A three-round Delphi process using a 9-point Likert scale based on expert results was distributed via survey. The final interactive meeting used a polling platform. PARTICIPANTS: The Pelvic Floor Disorders Consortium interdisciplinary group convened to advance the clinical care of pelvic floor disorders. MAIN OUTCOME MEASURES: To achieve expert consensus for core descriptor sets for rectal prolapse using a modified Delphi method. RESULTS: A total of 206 providers participated with survey response rates of 82% and 88% respectively. Responders were from North America 56%, Europe 29%, and Latin America, Asia, Australia, New Zealand, and Africa 15%. Ninety-one percent identified as colorectal surgeons and 80% reported more than 5 years of experience (35% > 15 years). Fifty-seven attendees participated in the final meeting and voted on core descriptor sets. Ninety-three percent agreed that descriptors such as age, body mass index, frailty, nutrition, and American Society of Anesthesiology Score correlated to physiologic status. One hundred percent agreed to include baseline bowel function. 100% reported willingness to complete a synoptic operative report. Follow-up intervals 1,3,5 year after surgery (76%) with a collection of recurrence, and functional outcomes at those time periods reached an agreement. LIMITATIONS: Individual bias, self-identification of experts, and paucity of the knowledge related to rectal prolapse. CONCLUSIONS: This represents the first steps toward international consensus to unify language and data collection processes for rectal prolapse. See Video Abstract.

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Cited by 5 publications

References 57 publications

Rectocele: Correlation Between Defecography and Physical Examination

Rectocele: Correlation Between Defecography and Physical Examination

The investigation of posterior compartment disorders: An integrated approach

Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus

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