Prospective Multicenter Trial Comparing Echodefecography With Defecography in the Assessment of Anorectal Dysfunction in Patients With Obstructed Defecation

Regadas, Francisco Sérgio Pinheiro; Haas, Eric M.; Abbas, Maher A.; Jorge, José Márcio Neves; Habr‐Gama, Angelita; Sands, Dana R.; Wexner, Steven D.; Amaral, Ingrid Melo; Sardiñas, Carlos; Lima, Doryane Maria dos Reis; Sagae, Evaldo U.; Murad-Regadas, Sthela M.

doi:10.1007/dcr.0b013e3182113ac7

Cited by 59 publications

(62 citation statements)

References 20 publications

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“…Images were acquired by moving two crystals (axial and longitudinal) on the extremity of the transducer, as described in previous publications (18,19,22) , producing a merged 3-D cube image recorded in real time for subsequent analysis in multiplanar images. Following rectal enema, patients were examined in the left lateral position.…”

Section: Methodsmentioning

confidence: 99%

“…E-mail: smregadas@hospitalsaocarlos.com.br or the middle compartment (entero/sigmoidocele grade III). The technique has been shown to correlate well with conventional defecography and has been validated in a prospective multicenter study (18,19,22) . Proper management of patients with pelvic floor dysfunctions requires extensive knowledge of the specific anatomy and physiopathology involved and, if available, dynamic diagnostic tools.…”

Section: Introductionmentioning

confidence: 96%

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Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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-Context -The correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. Objectives -To determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. Methods -Four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3D ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade II or III, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade III). In addition, sphincter damage was evaluated. Patients were grouped according to age (≤50y x >50y) and stratified by mode of delivery and parity: group I (≤50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group II (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. Additionally, patients were stratified by number of vaginal deliveries: 0 -nulliparous (n = 135), 1 -vaginal (n = 46), >1 -vaginal (n = 166). Results -Rectocele grade II or III, intussusception, rectocele + intussusception and sphincter damage were more prevalent in Group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001). The stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. Entero/sigmoidocele was more prevalent in the vaginal group ≤50y and in the nulliparous and vaginal groups >50y. No correlation was found between rectocele and the number of vaginal deliveries. Conclusion -Higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. However, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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“…The scanning sequence was the same as in Scan 2, visualizing and quantifying all anatomical structures and functional changes associated with voiding (rectocele, intussusception, Grade-III sigmoidocele/enterocele). Rectocele grade was previously defined through a comparison between echodefecography and defecography (28,32) (Figures 1 and 2). The measurement of rectocele grade were calculates by first drawing two parallel horizontal lines along the posterior vaginal wall, with one line placed in the initial straining position and the other line drawn at the point of maximal straining.…”

Section: Scanningmentioning

confidence: 99%

“…Radiologic methods for the dynamic evaluation of the obstruc ted defecation syndrome (ODS) include defecography, magnetic resonance imaging and ultrasonography, each of which has its advantages and limitations (4,5,6,10,14,20,22,24,25,28,32) . Different dynamic ultrasound techniques have been used to evaluate pelvic floor dysfunctions and demonstrated good correlation with conventional defecography (4,6,10,28) .…”

Section: Introductionmentioning

confidence: 99%

“…Different dynamic ultrasound techniques have been used to evaluate pelvic floor dysfunctions and demonstrated good correlation with conventional defecography (4,6,10,28) . One such technique, echodefecography (three-dimensional dynamic anorectal ultrasonography), developed by Murad-Re gadas et al (28) , has been shown to correlate well with defecography and was validated in a prospective multicenter study (28,32) . Echodefecography provides a visualization of all pelvic floor structures and changes during straining, making it possible to evaluate voiding disorders affecting posterior compartment (rectocele, rectal intussusception, anismus and mucosal prolapse) or the middle compartment (entero/sigmoidocele grade III).…”

Section: Introductionmentioning

confidence: 99%

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Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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-Context -Management of patients with obstructed defecation syndrome is still controversial. Objective -To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. Methods -The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Results -Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associa ted with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Conclusions -Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts. HEADINGS -Rectocele. Constipation. Pelvic floor. Imaging, three-dimensional.None disclosure.

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Imaging modalities for the detection of posterior compartment disorders in women with obstructed defaecation syndrome

Gruting

Stankiewicz

Thakar

et al. 2015

Cochrane Database of Systematic Reviews

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Prospective Multicenter Trial Comparing Echodefecography With Defecography in the Assessment of Anorectal Dysfunction in Patients With Obstructed Defecation

Cited by 59 publications

References 20 publications

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Imaging modalities for the detection of posterior compartment disorders in women with obstructed defaecation syndrome

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