Correlations of obstetric anal sphincter injury (OASIS) grade, specific symptoms of anal incontinence, and measurements by endoanal and transperineal ultrasound

Abstract

Purpose The aim of the study was to investigate the association between the initial grade of obstetrical anal sphincter injury (OASIS), and Wexner score parameters, with ultrasonographic findings by endoanal ultrasound (EAUS, golden standard) and transperineal ultrasound (TPUS) 6 months post-partum. Methods Fifty-nine women after primary repair of OASIS were included at Helsingborg Hospital, Sweden, 2016–2017. Six months post-partum the women filled in a questionnaire regarding symptoms of anal incontinence by the Wexner score and were scanned with EAUS and TPUS (resting state and contracting state) for classification of the residual defect by a modified Starck score. Results Correlations were found between the OASIS grade and residual defects; length (rs = 0.41, P = 0.003), depth (rs = 0.38, P = 0.006) and angle (rs = 0.40, P = 0.004) of the external anal sphincter (EAS) measured with TPUS in resting state. Using EAUS, correlation between OASIS grade and EAS depth (rs = 0.35, P = 0.007) and angle (rs = 0.37, P = 0.004) were similar, but there was no correlation with length (rs = 0.20, P = 0.14). Between incontinence to gas and the angle of the residual defect in the IAS using TPUS in resting state, correlation was moderate (rs = 0.42, P = 0.003). Regarding incontinence to liquid stool, measurements by TPUS in resting state of EAS residual defect depth (rs = 0.46, P < 0.001) and angle (rs = 0.44, P = 0.001) also correlated moderately. Both corresponding correlations using EAUS were weaker. Conclusion Defects measured with EAUS and TPUS six months post-partum correlated to initial OASIS grade and symptoms of anal incontinence. Specific symptoms correlated with specific anatomical defects, and TPUS was not an inferior method to EAUS.

Improved assessment of fecal incontinence in women with previous obstetric injury combining Low Anterior Resection Syndrome and Wexner scores

“…In a study by Ignell et al, the degree of obstetric anal sphincter damage correlated with the depth and angle of the defect in the EAS, and with the depth, angle, and length of the defect in the IAS when examined 6 months after delivery with endoanal ultrasound. Increasing degrees of obstetric anal sphincter defects were associated with incontinence of flatus and liquid feces as well as higher total Wexner scores 18 . However, the authors did not take urgency into consideration, a factor that has a profound effect on the patient's quality of life.…”

Consensus Definitions and Interpretation Templates for Dynamic Ultrasound Imaging of Defecatory Pelvic Floor Disorders

“…As the imaging quality of 3D systems improves, studies are progressively demonstrating a good correlation between endoanal aPFUS and transperineal pPFUS of the anal sphincter complex, particularly for OASIS, with sensitivity improving with expertise. 11,12 The technique has become one of the more common pelvic floor imaging modalities because of its availability. 13 Dynamic Endovaginal Pelvic Floor Ultrasound An vPFUS is performed using a side-fire transducer that obtains either axial or radial images of the pelvic floor.…”

“…The rendered 3D view and the axial multiplanar reformats are beneficial in determining the integrity of the levator ani muscles at their insertions and identifying levator ani avulsion. As the imaging quality of 3D systems improves, studies are progressively demonstrating a good correlation between endoanal aPFUS and transperineal pPFUS of the anal sphincter complex, particularly for OASIS, with sensitivity improving with expertise 11,12 . The technique has become one of the more common pelvic floor imaging modalities because of its availability 13 …”

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“…Pada bulan pertama, Ditemukan bahwa ada perbedaan signifikan pada rerata skor kekuatan otot panggul antara perempuan dengan defek dan tanpa defek sfingter ani (p<0.05), dimana perempuan tanpa defek sfingter ani (43.50±7.14) didapatkan rerata skor yang lebih tinggi daripada perempuan dengan defek sfingter ani (33.94±3.76); Pada bulan ketiga, Ditemukan bahwa ada perbedaan signifikan pada rerata skor kekuatan otot panggul antara perempuan dengan defek dan tanpa defek sfingter ani (p<0.05), dimana perempuan tanpa defek sfingter ani (45.99±6.86) didapatkan rerata skor yang lebih tinggi daripada perempuan dengan defek sfingter ani (30.90±1.80); sedangkan pada bulan keenam, Ditemukan bahwa ada perbedaan signifikan pada rerata skor kekuatan otot panggul antara perempuan dengan defek dan tanpa defek sfingter ani (p<0.05), dimana perempuan tanpa defek sfingter ani (49.77±5.86) didapatkan rerata skor yang lebih tinggi daripada perempuan dengan defek sfingter ani (34.83±1.56). 12 Sejalan dengan penelitian ini, ditemukan bahwa usia rata-rata Ruptur perineum derajat tiga dan empat yaitu 29.5±5.3 tahun (p=0,02). 13 Wanita primipara ditemukan lebih banyak yaitu 41 (80.4%) sampel daripada wanita dengan multipara yaitu 10 (19.6%).…”

“…Derajat 3b, 3c, dan 4 masingmasing memiliki insidensi sebanyak 17, 12, dan 6 wanita. 12 Pada penelitian ini, wanita tanpa faktor penyulit persalinan ditemukan sebanyak 42 (82.4%) sampel. Beberapa penyulit pada penelitian ini berupa penggunaan vakum, induksi atau akselerasi, dan presentase bokong.…”