Left lateral position and common gynecologic examining position in anal manometry measurements for evaluation of urogynecologic patients

Selçuk, Selçuk; Çam, Çetin; Asoğlu, Mehmet Reşit; Karateke, Ateş

doi:10.5152/jtgga.2014.14083

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Halani et al [ 25 ] reported that although there was no significant difference in the rectal volume measured in the left-lateral position compared with the lithotomy position in female FI patients, higher values for the measurements were observed in lithotomy than in the left-lateral position. Another study of urogynecological patients reported similar results [ 26 ]. In these studies, testing was performed first in the left-lateral position and then in the lithotomy position.…”

Section: Discussionsupporting

confidence: 67%

“…In our study, DDV and MTV were signi cantly higher in the erect position than in the left-lateral position in the 80 FI patients. The reason is unclear however, but testing was performed in the same sequence as previous studies [21,22], rst in the left-lateral position and then in the lithotomy position, which may have blunted rectal sensation during rectal capacity examination in the erect position. The order of examination should be reversed and re-examined in the future.…”

Section: Discussionmentioning

confidence: 99%

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Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

2022

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Purpose This study aimed to investigate the influence of erect position on anorectal manometry in patients with rectoanal intussusception (RAI). Methods This was a single center prospective observational study. Eighty female patients with fecal incontinence (FI) who underwent defecography between 1st January 2016 and 30th April 2022 were included. The effect of posture on commonly measured parameters during manometry was assessed in the left-lateral and erect positions. The severity of FI was assessed using FI Severity Index (FISI). Results Defecography showed that 30 patients had circumferential RAI (CRAI), and 50 had non-CRAI. There were no significant differences in age, parity, FI type, and FISI scores between the groups. However, FISI scores were significantly lower in 51 patients with passive FI than 12 patients with mixed FI type [21 (8–38) vs. 32 (8–43), P = 0.007]. Endo-anal ultrasound showed no significant difference in the incidence of sphincter defects between the groups. Maximum squeeze pressure was significantly lower in the erect position than in the left-lateral position in the CRAI patients [119 cm H2O (59‒454 cm H2O) vs. 145 cm H2O (65‒604 cm H2O), P = 0.006] however, this finding was not observed in the non-CRAI group and the subgroup of anterior RAI patients. In either group, maximum resting pressure, defecation desire volume, and maximum tolerated volume were significantly higher, while anal canal length was significantly shorter in the erect position than in the left-lateral position, respectively. Conclusion Voluntary contraction in female FI patients with CRAI was suppressed in the erect position.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

2022

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show abstract

“…Halani et al [21] reported that although there was no signi cant difference in the rectal volume measured in the left-lateral position compared with the lithotomy position in female FI patients, higher values for the measurements were observed in lithotomy than in the left-lateral position. Another study of urogynecological patients reported similar results [22]. In these studies, testing was performed rst in the left-lateral position and then in the lithotomy position.…”

Section: Discussionmentioning

confidence: 64%

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

Tsunoda

Takahashi

Osawa

2022

Preprint

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Purpose This study aimed to investigate the influence of erect position on anorectal manometry in patients with rectoanal intussusception (RAI). Methods This was a single center prospective observational study. Eighty female patients with fecal incontinence (FI) who underwent defecography between 1st January 2016 and 30th April 2022 were included. The effect of posture on commonly measured parameters during manometry was assessed in the left-lateral and erect positions. The severity of FI was assessed using FI Severity Index (FISI). Results Defecography showed that 30 patients had circumferential RAI (CRAI), and 50 had non-CRAI. There were no significant differences in age, parity, FI type, and FISI scores between the groups. Endo-anal ultrasound showed no significant difference in the incidence of sphincter defects between the groups. Maximum squeeze pressure was significantly lower in the erect position than in the left-lateral position in the CRAI patients [119 cm H2O (59‒454 cm H2O) vs 145 cm H2O (65‒604 cm H2O), P = 0.006] however, this finding was not observed in the non-CRAI group and the subgroup of anterior RAI patients. In either group, maximum resting pressure, defecation desire volume, and maximum tolerated volume were significantly higher, while anal canal length was significantly smaller in the erect position than in the left-lateral position, respectively. Conclusion Voluntary contraction in female FI patients with CRAI was suppressed in the erect position, which may have an additional effect on the appearance of FI.

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“…Whilst there is evidence in the literature that hip flexion alters the anorectal angle [15] as well as the activity and functionality of the pelvic floor [16], there is little to none empirically quantifying the degree or nature of alteration in the left lateral position when compared with the standard supine position. The complexity of this issue is compounded by the fact that merely moving the position of the body from left lateral to supine, even without flexion of the hips, has in itself been found to significantly move some elements of the abdominal and pelvic anatomy [17,18]. Although we are unable to quantify the effect this may have had on the fidelity of the models to the anatomy in the relevant position, we mitigated this error by aligning the anatomy with the data captured from position and pressure sensors, particularly during initial finger insertion through the anal canal.…”

Section: Discussionmentioning

confidence: 99%

Taking the Pressure Off the Patient – Understanding Digital Rectal Examinations on a Real Subject

Granados

Cox

Low‐Beer

et al. 2020

IEEE Trans. Biomed. Eng.

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Better understanding of palpation techniques during unsighted physical examinations has mostly been limited to qualitative and quantitative studies of performance of experts whilst conducting examinations on plastic benchtop models. However, little is known about their performance when conducting such examinations on real subjects. Objective: The aim of this paper is to better understand palpation techniques of experts whilst conducting a Digital Rectal Examination on a real subject. Methods: We recruited four consultants from relevant specialties and asked them to conduct two DREs on a Rectal Teaching Assistant whilst wearing small position and pressure sensors on their examining finger. We segmented the relevant anatomy from an MRI taken of the pelvic region, registered 3D models and analysed retrospectively performance in relation to executed tasks, supination/pronation, palpation convex hull and pressure applied. Results: Primary care consultants examined the anatomy more holistically compared to secondary care experts, the maximum pressure applied across experiments is 3.3N, overall the pressure applied on the prostate is higher than that applied to rectal walls, and the urologist participant not only applied the highest pressure but also did so with the highest most prominent frequency (15.4 and 25.3 Hz). Conclusions: The results of our research allow for better understanding of experts' technical performance from relevant specialities when conducting a DRE, and suggest the range of pressure applied whilst palpating anatomy. Significance: This research will be valuable in improving the design of haptics-based learning tools, as well as in encouraging reflection on palpation styles across different specialities to develop metrics of performance.

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Left lateral position and common gynecologic examining position in anal manometry measurements for evaluation of urogynecologic patients

Cited by 5 publications

References 5 publications

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

Taking the Pressure Off the Patient – Understanding Digital Rectal Examinations on a Real Subject

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