Role of MRI defecography in assessment of pelvic floor pathologies

Background: Functional disorders of the pelvic ?oor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspeci?c symptoms such as constipation or incontinence, remain dif?cult. MR Defecography has emerged over the last decade as a modality which additionally images the pelvic floor function in real time besides combining the advantages of previously used modalities and that of magnetic resonance i.e. multiplanar imaging, good temporal resolution and lack of radiation exposure. Dynamic MRI defecography is a relatively new imaging protocol which can be extremely useful in identification of anatomic and functional pelvic floor dysfunction such as organ prolapse, anismus and fecal incontinence. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic ?oor syndrome and descending perineum syndrome and visualization of enteroceles. The aim of the study was to assess causes of pelvic floor dysfunction.Methods: Authors evaluated 25 patients with cine Magnetic Resonance Defecography at our center between December 2018 and 15th May 2019. MR Defecography was done with help of 3 Tesla Somatom Seimens MRI. Ultrasound jelly was instilled into the rectum of patient via a short flexible tube while the patient lies in the lateral decubitus position on the scanner table before being moved into the gantry and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol while patient lied supine.Results: Most common complaint encountered was that of constipation. Patients in age group 20-70 years were studied. Maximum patient were of the age group 40-50 years. Most common finding was organ prolapse in total 9 patients with anterior rectocele in 6 patients followed by rectal prolapse.Conclusions: Magnetic resonance defecography is an excellent modality for assessment of pelvic floor disorders. It has very good temporal resolution and high soft tissue contrast, also allows visualization of the pelvic floor function in real-time without any radiation load. Imaging the defecation process in real-time leads to a definitive diagnosis in cases of dysfunctional defecation and a precise diagnostic and pre-operative assessment in cases of organ prolapse.

A new defecographic parameter for assessing rectal emptying / Um novo parâmetro defecográfico para avaliar o esvaziamento retal

ABSTRACT Purpose: To validate a new defecographic parameter to assess rectal empyting correlating the percentage of weight reduction of barium paste and the variation in the percentage of area reduction of rectum compared before and after defecation during cinedefecography. Method: Thirty-two consecutive female patients with dyschezia who had clinical indication for cinedefecography were selected. Their median age was 58 years old (18-78 years, mean = 55 years). During cinedefecography, we calculated the cross-sectional sagittal area of the rectum before and after defecation and, thus, the percentage of area reduction of the rectum. The percentage of weight reduction of barium paste was calculated after weighing the contrast injected into the rectum and the amount of contrast evacuated, in grams, using a scale. Finally, both percentages were compared and checked for a correlation between them. Pearson's correlation (r) and Student's t test were used for statistical analysis. Results: A correlation between evacuated barium paste and cross-sectional sagittal area of the rectum at the end of defecation was demonstrated (r = 0.668 and p < 0.0001). Conclusion: It is possible to estimate how much barium paste is evacuated based on the variations in cross-sectional sagittal area of the rectum before and after defecation, in cinedefecography.

RESUMO Objetivo: Validar um novo parâmetro defecográfico para avaliar o esvaziamento retal correlacionando o percentual de redução de peso da pasta baritada e a variação da porcentagem da redução da área do reto antes e depois da evacuação durante o exame de cinedefecografia. Métodos: Foram selecionadas 32 pacientes consecutivas do sexo feminino, portadoras de disquezia, com indicação clínica de investigação por cinedefecografia. A mediana de idade da amostra foi 58 anos (18-78 anos, média de 55 anos). Durante o exame de cinedefecografia, calcularam-se as áreas retais pela secção sagital antes e após a defecação e, assim, o percentual de redução da área retal. O percentual de redução do peso do contraste baritado foi calculado após medidas de peso do contraste injetado no reto e da quantidade de contraste evacuado, em gramas, utilizando uma balança. Por fim, os percentuais foram comparados e verificou-se se havia correlação entre eles. Para análise estatística, foram utilizados correlação de Pearson (r)eT este t de Student. Resultados: Foi observada correlação entre o contraste baritado evacuado e a área retal pela secção sagital ao final da evacuação (r = 0.668; p < 0.0001). Conclusões: É possível estimar o percentual de contraste baritado evacuado através da análise da variação da área retal pela secção sagital antes e após a evacuação, utilizando a cinedefecografia.

Defecographic Findings in Patients with Severe Idiopathic Chronic Constipation / 대한소화기학회지

BACKGROUND/AIMS: Chronic constipation is a common gastrointestinal disorder diagnosed using Rome III criteria. Defecography is a radiographic method used to identify anatomic abnormalities of anorectum. The present study aimed to evaluate the defecographic findings in patients with severe idiopathic chronic constipation. METHODS: One hundred patients, who complained of severe idiopathic chronic constipation with abnormal balloon expulsion test, underwent defecography after injection of barium. An analysis of radiographs was performed by an expert radiologist for the diagnosis of descending perineum syndrome, rectocele, enterocele, rectal ulcer, rectal prolapse, fecal residue of post defecation, and etc. Then, they were compared between the two sexes. RESULTS: Normal defecography was only observed in two participants. Descending perineum syndrome was the most common abnormality (73.3%). The results showed that rectocele (80.8%) and descending perineum syndrome (69.2%) were most frequent in women. In males, descending perineum syndrome and rectal prolapse were more prevalent (87% and 43.5%, respectively). Compared with men, rectocele and rectal ulcer were more frequently observed in women (p<0.001, and p=0.04, respectively), while men were more affected by descending perineum syndrome (p=0.04). In total, women had a greater incidence of abnormal defecographic findings compared with men (p=0.02). CONCLUSIONS: Defecography can be performed to detect anatomic abnormalities in patients with severe idiopathic chronic constipation and abnormal balloon expulsion test. This technique can assist physicians in making the most suitable decision for surgical procedure.

Defecography by digital radiography: experience in clinical practice / Defecografia por radiologia digital: experiência na prática clínica

Abstract Objective: The objective of this study was to profile patients who undergo defecography, by age and gender, as well as to describe the main imaging and diagnostic findings in this population. Materials and Methods: This was a retrospective, descriptive study of 39 patients, conducted between January 2012 and February 2014. The patients were evaluated in terms of age, gender, and diagnosis. They were stratified by age, and continuous variables are expressed as mean ± standard deviation. All possible quantitative defecography variables were evaluated, including rectal evacuation, perineal descent, and measures of the anal canal. Results: The majority (95%) of the patients were female. Patient ages ranged from 18 to 82 years (mean age, 52 ± 13 years): 10 patients were under 40 years of age; 18 were between 40 and 60 years of age; and 11 were over 60 years of age. All 39 of the patients evaluated had abnormal radiological findings. The most prevalent diagnoses were rectocele (in 77%) and enterocele (in 38%). Less prevalent diagnoses were vaginal prolapse, uterine prolapse, and Meckel's diverticulum (in 2%, for all). Conclusion: Although defecography is performed more often in women, both genders can benefit from the test. Defecography can be performed in order to detect complex disorders such as uterine and rectal prolapse, as well as to detect basic clinical conditions such as rectocele or enterocele.

Resumo Objetivo: Este estudo tem por objetivo descrever o perfil da população que se submeteu a exame de defecografia, de acordo com a faixa etária e sexo do paciente, bem como os principais achados e diagnósticos de imagem nesta população. Materiais e Métodos: Estudo retrospectivo e descritivo com 39 pacientes realizado entre janeiro de 2012 e fevereiro de 2014. Os pacientes foram avaliados quanto a idade, sexo e os diagnósticos encontrados. Foram divididos por idade, e as variáveis contínuas são expressas como média ± desvio-padrão. Todas as quantificações possíveis em defecografia foram realizadas neste trabalho, incluindo esvaziamento da ampola retal, descenso perineal e as medidas do canal anal. Resultados: Dos 39 pacientes estudados, todos apresentaram alterações radiológicas, sendo a maioria do sexo feminino (95%). O mais novo tinha 18 anos e o mais velho, 82 anos (idade média de 52 ± 13 anos). Dez pacientes tinham menos de 40 anos, 18 tinham entre 40 e 60 anos e 11 pacientes tinham mais do que 60 anos. Os diagnósticos mais prevalentes foram retocele anterior (77%) e enterocele (38%). Os menos frequentes foram prolapso vaginal (2%), prolapso uterino (2%) e divertículo de Meckel (2%). Conclusão: As mulheres realizam mais exames de defecografia, porém ambos os gêneros se beneficiam deste estudo. A defecografia é capaz de detectar causas complexas de distúrbio da defecação como prolapso vaginal, uterino e retal, e pode ser utilizada em condições clínicas mais simples como a avaliação de retocele ou enterocele.

Manifestaciones imagenológicas y manométricas en pacientes con estreñimiento funcional / Imaging and manometric manifestations in patients with functional constipation

INTRODUCCIÓN: el estreñimiento es un síntoma o afección que puede comprometer la calidad de vida de los pacientes. Su prevalencia global varía entre 2 % y 28 %. OBJETIVO: evaluar la concordancia entre los resultados de los exámenes imagenológicos y la manometría anorrectal, en pacientes con sospecha de estreñimiento funcional. MÉTODOS: la muestra estuvo conformada por 37 pacientes, a los que se les realizó exámenes radiológicos de cecocolografía secuencial (o colon por ingestión), tiempo de tránsito colónico con marcadores radiopacos, defecografía y examen manométrico. Se calculó el índice de Kappa para determinar la concordancia. RESULTADOS: 62,2 % de los enfermos fueron del sexo femenino, la edad predominante estuvo entre 41 y 60 años (43,2 %), predominó el ciego móvil (54,2 %) como causa de estreñimiento. Se hicieron 14 estudios de tiempo de tránsito colónico con marcadores radiopacos, de ellos 28,6 % presentó un tiempo de tránsito lento. Se realizó defecografía a 4 pacientes y 3 presentaron disfunción del suelo pelviano. Se constató que 94,6 % de las pruebas imagenológicas y 78,4 % de las manometrías resultaron positivas (Kappa p= 0,006). CONCLUSIÓN: las técnicas imagenológicas que se investigaron son apropiadas para diagnosticar el estreñimiento funcional y la concordancia de dichas técnicas con la manometría anorrectal es adecuada.

INTRODUCTION: constipation is a symptom or condition that can compromise the quality of patient's life. Its global prevalence varies between 2 % and 28 %. OBJECTIVE: evaluate the correlation between the results of imaging tests and anorectal manometry in patients with suspected functional constipation. METHODS: the sample consisted of 37 patients, who underwent radiological examinations of sequential cecocolografía (colon or swallowed), colonic transit time with radiopaque markers, defecography and manometric examination. Kappa index was calculated to determine the correlation. RESULTS: 62.2 % of patients were female, the predominant age was between 41 and 60 years (43.2 %), mobile blind predominated (54.2 %) as a cause of constipation. 14 studies of colonic transit time with radiopaque markers, were made, 28.6 % of them presented a slow transit time. 4 patients underwent defecography and 3 had pelvic floor dysfunction. It was found that 94.6 % of imaging tests and 78.4 % of manometries were positive (Kappa p= 0.006). CONCLUSIONS: imaging techniques used in this study are suitable for diagnosing functional constipation and consistency of these techniques is suitable anorectal manometry.

Effects of dynamic transperineal ultrasound and dynamic magnetic resonance imaging defecography in the diagnosis of rectocele / 中华消化外科杂志

Objective To evaluate the agreement between dynamic transperineal ultrasound (DTP-US)and dynamic magnetic resonance imaging defecography (DMRD) in the diagnosis of rectocele,and to compare the correlation and difference between the depth of rectocele measured by DTP-US and DMRD.Methods The clinical data of 18 female patients with rectocele who were admitted to the Third Affiliated Hospital of Nanjing University of Chinese Medicine from September 2011 to May 2012 were retrospectively analyzed.All patients received examination via DTP-US and DMRD,and the agreement of the 2 diagnosing methods was analysed.The accurate rates of the detection of other pelvic floor abnormalities by the 2 methods were calculated.The agreement of DTP-US and DMRD in diagnosing rectocele was analysed by Cohen's kappa test.The difference of the depth of rectocele measured by DTP-US and DMRD was compared by paired samplet test,and the correlation of the depth of rectocele measured by DTP-US and DMRD was analyzed by using the Pearson correlation coefficient.Results Of the 14 patients diagnosed by DTP-US,there were 7 patients with bladder prolapse,5 with unrelaxed pelvic floor,2 with uterine prolapse,2 with rectal internal mucous intussusception and 1 with enterocele; of the 18 patients diagnosed by DMRD,there were 12 patients with bladder prolapse,8 with unrelaxed pelvic floor,8 with uterine prolapse,6 with rectal internal mucous intussusception and 1 with enterocele.The agreement coefficient between DTP-US and DMRD in diagnosing rectocele was obvious (κ =0.737,P ＜ 0.05).The depth of the rectocele detected by DTP-US and DMRD were (15 ±6)mm (range,7-24 mm) and (27 ±7)mm (range,20-41 mm),with significant difference between the 2 groups (t =-16.124,P ＜0.05).There was a high coefficient between DTP-US and DMRD in detecting the depth of rectocele (| r | =0.874,P ＜ 0.05).The depth of rectocele detected by DMRD increased as the increase of depth of rectocele detected by DTP-US (| r | =1.000,P ＜ 0.05).Conclusions The agreement between DTP-US and DMRD in diagnosing rectocele is high.The depth of rectocele measured by the 2 methods not only has statistically significance,but also exists a high degree of correlation.While DTP-US is superior to DMRD in terms of quick diagnosis and better telerance of patients.

Features of anorectal manometry in patients with rectocele / 中华消化杂志

Objective To assess the anal and pelvic floor function in patients with rectocele (RC),and to afford the evidence for the treatments of RC.Methods Patients with functional constipation (FC) and healthy controls were consecutively enrolled,and all the subjects underwent defecography and anorectal manometry.According to defecography,the subjects were divided into four groups as no RC,mild RC,moderate RC and severe RC.The t-test,analysis of variance,rank sum test and Chi-square test were performed to compare the results of anorectal manometry between different RC groups in FC patients,and the results of anorectal manometry between moderate RC group in FC patients and control group with moderate RC were also compared.Results A total of 54 FC patients and 17 healthy controls were enrolled.No RC was found in all of male subjects.Of 48 female patients with FC,nine cases (18.8％) had no RC,seven (14.6％) had mild RC,18(37.5％) had moderate RC,and 14(29.2％) had severe RC.Three of the 12 female controls had no RC,one had mild RC,and eight had severe RC.Among all female patients with FC,the defecation rectal pressure in severe RC group ((34.4 ± 14.2) mmHg,1 mmHg=0.133 kPa) was significantly higher than of no RC group ((20.8 ± 13.1) mmHg,t=3.663,P=0.001),mild RC group ((19.1± 15.1) mmHg,t=3.719,P＜0.01) and moderateRC group ((25.6±16.3) mmHg,t=2.525,P=0.010).The left rectal pressure after defecation in mild RC group ((55.1 ± 19.7) mmHg) was significantly higher than that of moderate RC group ((43.3±17.6) mmHg,t=2.507,P=0.019) and severe RC group ((40.0±20.9) mmHg,t=2.619,P=0.006).The anal relax ratio in mild RC group (3.0％,0.5％ to 25.5％) was significantly lower than that of moderate RC group (19.5％,10.0％ to 29.0％,Z=-2.583,P=0.010) and severe RC group (22.0％,7.3％ to 54.5％,Z=-2.830,P=0.005).There were no significant differences in rectal and anal resting pressure,anal squeezing pressure,rectal sensory threshold and constituent ratio of manometry among four groups (all P＞0.05).The left rectal pressure after defecation in FC patients with moderate RC ((43.3 ± 17.6) mmHg) was significantly higher than that of controls with moderate RC ((26.3±20.8) mmHg,t=2.997,P＜0.01),and anal relax ratio was significantly lower than that of controls with moderateRC ((23.4±20.2)％ vs (55.2±16.3)％,t=-5.266,P=0.008).Conclusions RC is found in female and also found in individuals with normal defecation.FC patients with mild RC lack enough anal relax during defecation.However,defecation is relatively coordinate in FC patients with severe RC,which indicates that severe RC may be part of manifestation of pelvic floor relaxation.

Application of static and dynamic virtual defecography in the etiological diagnosis of constipation / 中国基层医药

Objective To explore the applied value of static and dynamic of virtual defecography technology in the etiological diagnosis of constipation.Methods 50 patients with constipation were included.Conventional cleaning enema was performed firstly.Then they were injected the virtual defecography agentwith lateral position,filling the rectum,sigmoid and descending colon.Thirdly,siting on the qualities commode,adjusting height coincides with the left and right femur,displaying the pubic symphysis and coccyx dynamic acquisition image acquisition with the speed of 4/s,the dynamic changes of the rectum and anal canal were analyzed and measured.Results Among 50 patients,32 cases with rectocele,1 case with rectal bend,2 cases with anal canal stenosis,7 cases with rectal prolapse,4 cases pelvic floor spasm syndrome,and 4 cases with no cause.Conclusion Static and dynamic virtualdefecography was an important method in the etiological diagnosis of patients with constipation.

Significance of defecographic parameters in diagnosing pelvic floor dyssynergia / 대한외과학회지

PURPOSE: Defecography is known to be a sensitive and specific measurement of pelvic floor dyssynergia (PFD). However, its standardized parameter for diagnostic analysis is still incomplete. We attempted to determine which defecographic findings are most significant for PFD, and how closely they match other physiologic tests and clinical symptoms of functional pelvic outlet obstruction. METHODS: Ninety-six patients with constipation who completed work-up of their symptoms with defecography, anorectal manometry and electromyography (EMG) were included in the study. Internal consistency of defecographic findings, and agreements between defecographic findings and results of other tests were statistically analyzed (Crohnbach's alpha, Cohen's kappa, respectively). RESULTS: Of the 96 patients evaluated, obstructive symptoms of constipation were obvious in 35 (36.5%) by obstructive symptom score. As known defecographic findings for PFD, poor opening of the anal canal was found in 33 (34.4%), persistent posterior angulation of the rectum in 33 (34.4%), and poor emptying of the rectum in 61 (63.5%). Manometric defecation index, manometric evacuation index, and EMG findings compatible with PFD were in 81 (84.4%), 72 (75%), and 73 (76%), respectively. Internal consistency of three defecographic findings was good (alpha = 0.78). Agreements between each defecographic findings and each result of other tests were all poor. CONCLUSION: Among known defecographic findings for PFD, one specific finding cannot be considered more important than the others for its diagnosis. It is hard to expect consistent results of various diagnostic tests and to predict the presence of defecographic PFD by use of anorectal manometry, EMG, or even by clinical symptoms.

An Analysis of Factors Associated with Increased Perineal Descent in Women

PURPOSE: Treatment of descending perineal syndrome is focused on personal etiology and on improving symptoms. However, the etiology of increased perineal descent (PD) is unclear. Therefore, the aim of the present study was to evaluate factors associated with increased resting and dynamic PD in women. METHODS: From January 2004 to August 2010, defecographic findings in 201 female patients were reviewed retrospectively. Patient's age, surgical history, manometric results and defecographic findings were compared with resting and dynamic PD. RESULTS: Age (P < 0.01), number of vaginal deliveries (P < 0.01) and resting anorectal angle (P < 0.01) were correlated with increased resting PD. Also, findings of rectoceles (P < 0.05) and intussusceptions (P < 0.05) were significantly correlated with increased resting PD. On the other hand, increased dynamic PD was correlated with age (P < 0.05), resting anal pressure (P < 0.01) and sigmoidoceles (P < 0.05). No significant correlation existed between non-relaxing puborectalis, history of pelvic surgery and increased PD. Also, no significant differences in PD according to the symptoms were observed. CONCLUSION: Increased number of vaginal deliveries and increased resting rectoanal angle are associated with increased resting PD whereas increased resting anal pressure is correlated with increased dynamic PD. Older age correlates with both resting and dynamic PD. Defecographic findings, such as rectoceles and intussusceptions, are associated with resting PD, and sigmoidoceles correlated with dynamic PD. These results can serve as foundational research for understanding the pathophysiology and causes of increasing PD in women better and for finding a fundamental method of treatment.

What is the value of proctography for diagnostic of outlet obstruction?

The diagnosis of constipation is complicated due to the multiplicity and complexity of the causes. Regarding diagnostic tests, proctography is the best choice because it provides information on functions and visualization of abnormalities. Objective: To measure the isolated value of proctography in patients with obstructed defecation. Method: We evaluated 40 constipated patients at the Coloproctology Clinic of Santa Casa de Misericórdia de São Paulo. The test was performed by introducing 120 mL of barium contrast in the rectum and by analyzing the different stages of evacuation. Three x-rays were performed in the lateral position: rest, anal contraction and evacuation. Results: The diagnoses were: rectocele: 2 (5.0%); anismus: 8 (20.0%); perineal descent: 13 (32.5%); sigmoidocele: 6 (15.0%); internal invagination: 10 (25.0%); rectocele + sigmoidocele 9 (22.5%); rectocele + internal invagination 11 (27.5%); rectocele + anismus: 18 (45.0%). Several patients presented multiple disorders. Conclusion: Constipation by obstructed defecation depends on multiple factors and it is important to have an accurate diagnosis. Proctography is essential, but insufficient as a single procedure. The other tests contribute with the diagnosis, therefore, they should be included in the investigation.(AU)

O diagnóstico da constipação é difícil pela multiplicidade e complexidade das causas. Dos exames diagnósticos, a proctografia é preferida, fornecendo informações da função e visualização de anormalidades. Objetivo: Medir o valor isolado da proctografia, em pacientes com diagnóstico de defecação obstruída. Método: Avaliamos 40 pacientes com constipação intestinal do Ambulatório de Coloproctologia da Santa Casa de Misericórdia de São Paulo. O exame foi feito introduzindo-se 120 mL de contraste no reto e analisando-se as diferentes fases da evacuação. Foram realizadas três radiografias na posição lateral: repouso, contração anal e evacuação. Resultados: Os diagnósticos foram: retocele: 2 (5,0%); contração paradoxal do puborretal: 8 (20,0%); descida perineal: 13 (32,5%); sigmoidocele: 6 (15,0%); invaginação interna: 10 (25,0%); retocele + sigmoidocele: 9 (22,5%); retocele + invaginação: 11 (27,5%); retocele + contração paradoxal: 18 (45,0%). Vários pacientes apresentaram distúrbios múltiplos. Conclusão: Constipação por defecação obstruída depende de múltiplos fatores e é importante o diagnóstico preciso. A proctografia é essencial, mas insuficiente como procedimento isolado. Os outros exames são importante contribuição para firmar o diagnóstico, devendo ser incluídos na investigação. (AU)

How to Interpret a Functional or Motility Test - Defecography

Defecography evaluates in real time the morphology of rectum and anal canal in a physiologic setting by injection of a thick barium paste into the rectum and its subsequent evacuation. Because of its ability of structural and functional evaluation, defecography is primarily performed for work up of patients with longstanding constipation, unexplained anal or rectal pain, residual sensation after defecation or suspected prolapse. Technique and interpretation of this examination are outlined in this review.

Defecografía por resonancia magnética / Magnetic resonance defecography

The term disorders of the anorectal function encompasses a group of diseases commonly present in gastroenterological consultation; conditions that have a significant impact on patients' quality of life. Imaging studies, mainly defecography, are essential for the diagnosis of these diseases. Taking into account that there is overlap of several of them in the same patient, some may be underdiagnosed when relying solely on anamnesis and physical examination. Given the multiplanar capability of MRI, visualization ofperirectal soft tissue, its lowest invasiveness in relation with other studies and the absence of ionizing radiation or barium, MRI defecography has been installed as an imaging modality widely used in our milieu, replacing the classical defecography performed under fluoroscopy.

Los trastornos de la función anorrectal están constituidos por un grupo de patologías frecuentes en la consulta gastroenterológica, que determinan un impacto en la calidad de vida. Los estudios de imagen, en especial la defecografía, son fundamentales para el diagnóstico de estas patologías; si se considera que hay traslape de varias de ellas en un mismo paciente, algunas pueden quedar subdiagnosticadas al contar solamente con la anamnesis y el examen físico. Dada la capacidad multiplanar de la resonancia magnética, la visualización de las partes blandas perirrectales, su menor invasividad en relación a otros estudios y el no uso de radiación ionizante ni bario, la defecografía por resonancia magnética se ha instalado como una modalidad de imagen de amplio uso en nuestro medio, reemplazando a la defecografía clásica efectuada bajo fluoroscopía.

Value of postoperative pelvic four-contrast defecography in the patients with outlet obstructive constipation / 中华全科医师杂志

Twenty two patients with outlet obstructive constipation (OOC) underwent pelvic fourcontrast defecography preoperatively and postoperatively. Functional outcome and the findings on defecography were analyzed. The inconsistent signs between preoperative and postoperative defecography findings were shown in all patients. Some new abnormal findings, including 5 cases with pelvic floor hernia, 4 with cystocele, 4 with vagina prolapse, 3 with uterine prolapse,2 with rectal prolapsed and 1 with spastic pelvic floor syndrome were present in 5 patients with ineffective surgical treatment and 9 patients with effective surgical treatment. Reduced abnormal signs were showed in the 9 effective patients, but other new abnormalities appeared. The abnormal signs were reduced or disappeared in 8 obviously effective patients and there were no new abnormalities present in those patients. Results indicate that pelvic four-contrast defecography can provide valuable information for patients with OOC postoperatively.

Study of the Morphology of Rectum and Its Clinical Value in Patients with Internal Prolapse of Rectum / 实用放射学杂志

Objective To evaluate the changes of rectal morphology and its clinical value in internal rectal prolapse.Methods The rectal morphology of internal rectal prolapse in thirty-one patients with functional constipation and ten normal control subjects was analysed with defecography.The data were analysed with Mann-Whitney Unonparametric test and Fisher's exact test.Results 23 cases and 2 cases with rectal intussusception in patients group and control group respectively were found.Fisher's exact test was P=0.007.In patients group and control group,the thicknesses of anterior intussusception were(13.51 ±9.42)mm and(3.68±2.34)mm,and posterior intussusception were(5.36±3.92)mm and(2.82±0.99)mm respectively;the intussuscipiens diameters were (37.19±11.79)mm and(25.32±9.25)mm,the intussusceptum lumen diameters were(14.91±4.74)mm and(19.73±6.36)mm,the ratio of intussuscipiens diameters and lumen diameters were 2.82±1.64 and 1.28±0.12,the maximum rectal diameter were(48.97±9.55)mm and(39.84±8.45)mm at rest state.There were significant differences between patients group and control group in above varied values(P＜0.05).Conclusion Defecography can differentiate whole thickness rectal intussusception from rectal mucosal prolapse,which provides the scientific basis for choosing the reasonable treatment.However,caution is required when selecting patients for treatment interventions based on defecography.

Numerial defecography for 60 cases with obstinate constipation / 中国基层医药

Objective To discuss the numerial defecography for cases with obstinate constipation.Methods A retrospective study of the data of 60 cases with obstinate constipation,was carried on the radiodiagnosis through the ralative measurement. Results 25 cases with the perineum descending,16 cases with the anterior mucosal prolapse,37 cases with the internal rectal intussusception,12 cases with the external rectal prolapse,47 cases with the rectocele,13 cases with the spastic pelvic floor syndrome,39 cases with the puborectalis muscle hypertrophy,11 cases with the enterocele,12 cases with the sacrum-rectal separate,and 10 cases with the achalasia of anal muscle of internal enlarge. Conclusion It was important that numerial defecography in the diagnosis of obstinate constipation.

Usefulness of Colon Transit Time and Defecography in Patients with Chronic Constipation

PURPOSE: We wanted to evaluate whether both the colonic transit time (CTT) and defecography are necessary for diagnosing constipated patients, and we also wanted to assess the defecographic findings of patients with outlet obstruction on CTT. MATERIALS AND METHODS: Over the recent 3 years, 26 patients (21 women and 5 men, mean age: 59 years) underwent both CTT and defecography because of their chronic constipation or defecation difficulty. The mean interval between the 2 studies was 48 days. Colonoscopy, barium enema and manometry were performed in 22, 8 and all the patients, respectively. RESULTS: On CTT, 13 patients (50.0%) were normal and 13 patients (50.0%) were abnormal; the abnormal results were composed of outlet obstruction (n=8, 30.8%), outlet obstruction and colon inertia (n=2, 7.7%), colon inertia (n=2, 7.7%), and outlet obstruction and hindgut dysfunction (n=1, 3.8%). On defecography, 6 patients (23.1%) were normal and 20 patients (76.9%) were abnormal; the results were composed of rectocele (n=8, 30.7%), rectocele and perineal descent syndrome (PDS; n=4, 15.4%), PDS and rectal intussusception (n=3, 11.5%), spastic pelvic floor syndrome (SPFS; n=3, 11.5%), rectocele and SPFS (n=1, 3.8%), and rectal intussusception (n=1, 3.8%). Of the 11 patients with outlet obstruction on CTT, rectocele (n=4, 36.4%), SPFS (n=1, 9.1%), rectocele and PDS (n=1, 9.1%), and PDS and rectal intussusception (n=1, 9.1%) were demonstrated on defecography, except for the 4 normal cases. CONCLUSION: Both CTT and defecography were necessary for diagnosing the patients with chronic constipation in compensation, and 63.6% of the patients with pelvic outlet obstruction showed an abnormal pelvic defecation function.

The Efficacy of Dynamic Colpocystodefecography in Pelvic Organ Prolapse / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy of dynamic colpocystodefecography in patients with a pelvic organ prolapse. MATERIALS AND METHODS: A total of 63 patients, with or without stress urinary incontinence and pelvic organ prolapse, who visited our hospital between April 2002 and July 2003, were studied. All patients were available for physical examination and dynamic colpocystodefecography. The patient was seated on a radiolucent commode, which was upright on the end of a vertically oriented x-ray table. Deliberate efforts were made to ensure privacy. Fluoroscopic images were taken during resting, squeezing, Valsalva effort, voiding and defecation. RESULTS: On physical examination, cystocele, rectocele and rectal intussusception were revealed in 26 (36%), 20 (31%) and 7 cases (11%), respectively. On dynamic colpocystodefecography, cystocele, rectocele and rectal intussusception were revealed in 44 (69%), 32 (50%) and 15 cases (24%), respectively. Compared with the physical examination, 18 cases of cystocele, 12 of rectocele and 8 of rectal intussusception were newly found through dynamic colpocystodefecography. Enterocele and sigmoidocele were not found in the physical examination, but only found through dynamic colpocystodefecography in 4 and 5 cases, respectively. The degree of prolapse was more severe during defecation than voiding. CONCLUSIONS: Not all the pelvic organ prolapses were detected on physical examination. Radiological evaluation is necessary for a more accurate detection of a pelvic organ prolapse. Dynamic colpocystodefecography has the advantages of it's ability to be performed for physiological defecation and voiding status, as well as imaging of dynamic pelvic organ structures.

Pattern Analysis of Defecography in Patients with Chronic Functional Constipation: Is It Predictable for the Responsiveness of Biofeedback Therapy?

PURPOSE: To determine if pattern analysis of defecography can predict the responsiveness of biofeedback therapy in patients with chronic functional constipation. MATERIALS AND METHODS: Over a two-year period, 104 patients with chronic functional constipation underwent defecography and biofeedback therapy. Two blinded readers analyzed the defecographic findings and classified them into six types; I = normal defecation, II = hypertonic lower anal sphincter (poor anal opening due to a persistent contraction of the lower anal sphincter), III = dyskinetic puborectal sling (inadequate laxity of the puborectal sling), IV = spastic pelvic floor syndrome (persistent contraction of both the puborectal sling and the lower anal sphincter), V = unclassified (including paradoxical contraction of the anal sphincter), VI = anatomical obstruction. In addition, the degree of rectal contraction during defecation was scored (grade 0 to 3). After biofeedback therapy, the differences in the defecography patterns or rectal contractions between the two groups, the responsive or non-responsive group, were analyzed. RESULTS: The defecograms revealed that the type IV of the spastic pelvic floor syndrome was most common (50 of 104 patients, 48%), followed by II (21/104, 20%), III (12/104, 11.5%), V (9/104, 9%) and VI (12/104, 11.5%). Biofeedback therapy showed a therapeutic response in 71 out of 104 patients (68%) but failed in 33 patients (32%). However, there were no significant differences in the defecographic pattern between the responsive and non-responsive groups (p=0.630). The defecograms revealed rectal contractions in 78 patients (75%) and moderate to vigorous contractions (more than grade 2) in 66 patients. Most of the biofeedback-responsive group showed rectal contractions (66 of 71 patients, 93%, p<0.001). CONCLUSION: In patients with chronic functional constipation, there was no significant difference in the morphological patterns of the defecogram between the responsive and non-responsive biofeedback groups. However, the presence of rectal contractions during defecation was strongly associated with the therapeutic response after biofeedback therapy.

Investigation of Defecographic Findings in Patients with Pelvic Outlet Obstructive Disease

PURPOSE: Defecography is a dynamic investigation which can influence clinical decision making in patients with pelvic outlet obstructive disease (POOD). The current study was designed to establish defecographic findings in patients with POOD. Specifically, we sought to assess the physiologic characteristics of categorized types by using anorectal physiologic tests. METHODS: One hundred seven patients (disease group; 45 men, 62 women) with POOD were retrospectively categorized as type I [non-relaxation of puborectalis (NRPR) only, n=19], type II [NRPR and rectocele, n=20], type III [NRPR, rectocele, and dynamic perineal descent (PD), n=17], type IV [deformed rectocele, mild-to-moderate fixed PD, and absence of NRPR, n=29], and type V [rectocele, severe fixed PD, and absence of NRPR, n=20] on the bases of defecographic findings. The ability to evacuate, the frequency/degree of intarectal intussusception (IRI), and the size of the rectocele were evaulated in these defecographic types of POOD. Age, duration of symptoms, and the physiologic findings of anal manometry and EMG/PNTML were compared for the five types. Eighteen healthy volunteers who had no defecation difficulty were used to estimate the normal findings of defecography. RESULTS: The age and the sex showed no significant differences among the types. The duration of symptoms was gradually lengthened from type I to V (P<0.01). The ability to evacuate in patients with POOD was significantly worse (failed to effectively evacuate) compared to that in the healthy volunteers (P<0.01). The frequency of IRI was increased more and more from type I to V (P<0.01). The size of the rectocele was significantly increased in types V compared to the other types (P<0.01). Manometric and neurologic findings, including EMG/PNTML, revealed no significant differences among the types. CONCLUSIONS: Even though there were no specific differences in the findings of the anal manometric and neurologic tests, the evacuation dynamics; were different in the five defecographic categories of patients with POOD. Specifically, these differences were relevants to the presence of NRPR, rectoceles, IRI, and perineal descent.