Postpartum evaluation of the anal sphincter by transperineal three‐dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third‐degree tears by the overlapping technique

Valsky, D. V.; Messing, B.; Petkova, Ralitsa; Savchev, S.; Rosenak, D.; Hochner‐Celnikier, D.

doi:10.1002/uog.3923

Cited by 68 publications

(55 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, one should be aware that when using these methods not all anal sphincter defects will be identified. The recent use of 3D TPU in post-partum women is promising, 31 but needs to be compared to EAU.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

Roos¹,

Abdool²,

Sultan³

et al. 2011

Clinical Radiology

View full text Add to dashboard Cite

AIM: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence.MATERIALS AND METHODS: One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B&K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard.RESULTS: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30e67%) and 85% (77e91%) for EVU and 64% (44e81%) and 85% (77e91%) for TPU, respectively. CONCLUSION: Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.

show abstract

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

Roos¹,

Abdool²,

Sultan³

et al. 2011

Clinical Radiology

View full text Add to dashboard Cite

show abstract

“…The images obtained included both longitudinal and transverse views. Each internal and external anal sphincter were carefully examined in the axial plane to assess continuity, and the presence or absence of a defect was recorded, as previously reported [17,18].…”

Section: Methodsmentioning

confidence: 99%

Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?

Abramov

Feiner²,

Rosen³

et al. 2008

Int Urogynecol J

View full text Add to dashboard Cite

Advanced obstetric anal sphincter tears are often associated with a high incidence of fecal and flatus incontinence. We aimed to assess the clinical outcome of these repairs when done by the overlapping sphincteroplasty technique with reconstruction of the internal anal sphincter and perineum. Between August 2005 and December 2006, all grades 3 and 4 obstetric anal sphincter tears in our department were repaired by a reconstructive pelvic surgeon, primarily using the overlapping sphincteroplasty technique with reconstruction of the internal anal sphincter and perineum. All women were followed every 6 months using the Colorectal Anal Distress Inventory and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, a physical examination of the anal sphincter, anal manometry, and transperineal anal sonography. There were 3,478 deliveries of which 22 (0.63%) anal sphincter tears were repaired in women aged 22-41 years. Two women were diagnosed with Royal College of Obstetricians and Gynecologists grade 3a, eight with grade 3b, nine with grade 3c, and three with grade 4 anal sphincter tears. Postoperatively, 21 patients attended the outpatient clinic, with an average follow-up time of 9.2+/-1.4 months. Only two women (9.5%) complained of flatus incontinence and fecal urgency and had mildly decreased anal sphincter squeeze pressure and a small sonographic anal sphincter defect. None of the women complained of fecal incontinence. Two women (9.5%) reported on transient perineal pain and one (4.8%) on transient dyspareunia. All other women were asymptomatic and had normal anal manometry and sonographic evaluation. Repair of obstetric anal sphincter tears using the overlapping sphincteroplasty technique with reconstruction of the internal anal sphincter and perineum seems to carry favorable clinical outcome and reduced risk for anal incontinence, perineal pain, and sexual dysfunction.

show abstract

“…Early recog nition, particularly during the immediate postpartum period, and surgical repair are fundamental to reduce later anal incontinence [46] . Four ultrasonographic signs indicative of damage after repair were defined as EAS or IAS sphincter discontinuity, thickening of the EAS at the 12o'clock position, thinning of the IAS in the area of rupture in conjunction with thickening opposite the rupture site (the "halfmoon" sign), and abnormality of the mucous folds [47,48] . The PREDICT [49] study revealed that 2D TPUS had a sensitivity and specificity of 64% and 85%, respectively, for detecting sphincter defect when compared with EAUS.…”

Section: Fecal Incontinencementioning

confidence: 99%

“…There are several studies showing that 3D TPUS is an accessible, inexpensive and confortable method, allowing good sphincter evaluation in the postpartum period and also following surgical repair [47,48,53] . This technique has a multiplanar image, more precise volume calculation, and shorter examination period, with a possibility for a second opinion consultation, without the presence of the patient [47] .…”

Section: Fecal Incontinencementioning

confidence: 99%

“…This technique has a multiplanar image, more precise volume calculation, and shorter examination period, with a possibility for a second opinion consultation, without the presence of the patient [47] . Nonetheless, most of these studies have an important limitation because authors did not perform a direct comparison of the 3DTPUS images with the currently considered gold standard, EAUS.…”

Section: Fecal Incontinencementioning

confidence: 99%

See 1 more Smart Citation

Current applications of transperineal ultrasound in gastroenterology

Albuquerque¹,

Pereira²

2016

WJR

View full text Add to dashboard Cite

Transperineal ultrasound is an inexpensive, safe and painless technique that dynamically and noninvasively evaluates the anorectal area. It has multiple indications, mainly in urology, gynaecology, surgery and gastroenterology, with increased use in the last decade. It is performed with conventional probes, positioned directly above the anus, and may capture images of the anal canal, rectum, puborectalis muscle (posterior compartment), vagina, uterus, (central compartment), urethra and urinary bladder (anterior compartment). Evacuatory disorders and pelvic floor dysfunction, like rectoceles, enteroceles, rectoanal intussusception, pelvic floor dyssynergy can be diagnosed using this technique. It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature, with images obtained at rest, straining and sustained squeezing. This technique is an accurate examination for detecting, classifying and following of perianal inflammatory disease. It can also be used to sonographically guide drainage of deep pelvic abscesses, mainly in patients who cannot undergo conventional drainage. Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence, postpartum and also following surgical repair of obstetric tears. There are also some studies referring to its role in anal stenosis, for the measurement of the anal cushions in haemorrhoids and in chronic anal pain. structures interaction during defecation stimulation manoeuvres, as well as the identification, classification, and follow-up in inflammatory perianal disease, and it can also identify sphincter injury in fecal incontinence. In this review the technique is described and the current evidence that supports its use in several areas is also discussed.Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology.

show abstract

Postpartum evaluation of the anal sphincter by transperineal three‐dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third‐degree tears by the overlapping technique

Abstract: ABSTRACT

Cited by 68 publications

References 30 publications

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?

Current applications of transperineal ultrasound in gastroenterology

Contact Info

Product

Resources

About