The Clinical and Physiologic Characteristics of Patients with Pelvic Outlet Obstructive Disease

PURPOSE: With recent anorectal physiologic studies, functional etiologies of pelvic outlet obstructive disease were evaluated in detail. The current study was designed to assess the clinical and the physiologic characteristics of patients with pelvic outlet obstructive disease. METHODS: one hundred two (102) patients with pelvic outlet obstructive disease were evaluated with anorectal physiologic studies, including the colonic transit time (n=66), anorectal manometry (n=88), defecography (n=102), anal sphincter EMG (n=50), and colonoscopy or barium enema (n=77). The patients were categorized as group I (nonrelaxing puborectalis syndrome), group II (rectocele), group III (sigmoidocele), and group IV (rectoanal intussusception). The clinical and the physiologic characteristics were compared between the groups. RESULTS: The mean age was 51.9 years, and the sex ratio was 1:1.9. the populations of the groups were group I 45.1% (n=46), group II 36.3% (n=37), group III 5.9% (n=6), and group IV 9.8% (n=10). In group II and group III, co-existing etiologies were more, and the incidences of female patients was higher (P<0.05). Delayed colonic transit time was noted in 11 patients (17%). Diverticula was observed in 6 patients (8%), polyps in 12 patients (16%), and melanosis coli in 14 patients (18%). On anorectal manometry, group I showed higher maximal voluntary contraction and mean squeezing pressure than the other groups (P<0.05). On defecography, group I had a shorter perineal descent at rest and a smaller anorectal angle at push (P<0.05). CONCLUSIONS: The current study showed the clinical and the physiologic characteristics of the each functional etiology in patients with pelvic outlet obstructive disease. These results provide fundamental data for diagnosis of and tailored therapy for pelvic outlet obstructive disease.

Physiologic Characteristics and its Clinical Significances in the Patients with Pelvic Outlet Obstruction

Current study was designed to assess the functional etiology of patients with pelvic outlet obstruction. Moreover, physiologic characteristics and theirs clinical significances were evaluated in the patients with ramified diagnosis. METHODS: 172 patients with pelvic outlet obstruction were performed 328 numbers of physiologic studies. These included cinedefecography (n=172), anal manometry (n=87), colonic transit time study (n=38), and anal EMG/PNTML (n=31). On the basis of physiologic findings, patient groups were categorized as rectocele (group I), nonrelaxing puborectalis syndrome (group II), anal dyschezia (group III), and rectoanal intussusception (group IV). The physiologic findings were compared between subgroup patients. RESULTS: Incidence of categorized patients was 51.7% (group I, n=89), 22.7% (group II, n=39), 12.2% (group III, n=21), and 8.7% (group IV, n=15), respectively. The mean age of patients with group III were lower (p<0.05) than that of overall patients. The incidence of female patients was higher in group I and the incidence of male patients was higher in group II (p<0.0001). In cinedefecography, patients with group II showed smaller anorectal angle at strain (p<0.001), at dynamic change between rest and strain (p=0.002). In anal manometry, patients with group III showed higher mean resting pressures (p=0.001), higher maximum resting pressures (p<0.001), higher mean squeeze pressures, and higher maximal voluntary contraction (p=0.003) than those of patients with other group. In neurologic study, mean value of PNTML was 2.32 +/- 0.34 (range, 1.60~3.66) msec in overall patients. The size of rectocele was increased in proportion to patient's age (r=0.229, p<0.05), number of delivery (r=0.393, p=0.001), and degree of perineal descent (r=0.231, p<0.05). The degree of perineal descent was increased in proportion to patient's age (r=0.249, p<0.05). CONCLUSIONS: Present series provided the diagnostic ramification of pelvic outlet obstruction by using the anorectal physiologic investigations. In addition to the function of puborectalis muscle, evacuation dynamics of anorectum should be emphasized. These findings could provide the fundamental information for guideline of future therapy in the patients with obstructed defecation.