The role of tridimensional dynamic ultrasound for pelvic floor evaluation.

INTRODUCTION: Dynamic endoanal ultrasound has emerged in recent years as a test that could replace the now existing tests in the diagnosis of pelvic floor disorders. The aim of this paper is to determine the usefulness of echodefecography in the diagnosis and evaluation of patients with symptoms of anorrectal obstruction, and show the results obtained after its implementation in a pelvic floor unit, as a complementary tool that could replace conventional defecography. METHODS: In this retrospective study we analyzed 66 patients with a mean age of 55 years (19-83), 61 women (92%). All dynamic ultrasound was performed in 3 dimensions and was correlated with symptoms and physical findings in the consultation. A descriptive and inferential study was performed to find a kappa correlation between physical examination and echodefecography. RESULTS: The reasons for consultation were: Anorrectal obstruction syndrome 36 patients (54.5%), pelvic organ prolapse 27 patients (40.9%), and anorrectal obstruction syndrome along with pelvic organ prolapse 3 patients (4.5%). The correlation of the 2 groups indicated that echodefecography diagnosed more patients with grade III rectocele, enteroceles, and anismus than the combination of scan-ultrasound-manometry-proctoscopy (Kappa 0.26, 0.38 and 0.21, 95% CI: from 0,07 to 1.00, 0.15 to 1.00 and from 0.12 to 1.00, respectively) (P<.001). Conversely, echodefecography diagnosed less perineal descense (Kappa 0.28, 95% CI: 0.12 to 1.00). CONCLUSIONS: Dynamic anal ultrasonography may have a role as a complementary test in patients with pelvic floor disorders, achieving diagnoses that would go undetected by inspection, physical examination and manometry.

Presentación de nueva técnica: ecografía tridimensional dinámica endorrectal (Ecodefecografía) en el estudio de pacientes con síndrome de obstrucción del tracto de salida. Técnica y resultados. Primera experiencia en la Argentina / Presentation of new technique dynamic three dimensional endorectal ultrasound (Echodefecography) in the patients study with obstructed defecation syndrome. Technique and results. First experience in Argentina

Objetivos: describir un reciente método para evaluar pacientes con síntomas de obstrucción del tracto de salida, y mostrar nuestra experiencia inicial y resultados obtenidos. Material y Métodos: se estudiaron, en el período comprendido entre mayo 2011 y mayo 2013, a pacientes con síntomas de dificultad evacuatoria utilizando la ecografía anorrectal dinámica según la técnica descripta. Los estudios fueron efectuados por 2 operadores entrenados en el método. Resultados: se realizaron 89 ecodefecografías en 88 pacientes, en un período de 24 meses. La ecodefecografía detectó rectocele en el 65% de los pacientes estudiados, seguido de intususcepción y anismo en el 54 y 45%, respectivamente. Conclusión: la ecodefecografía es un método útil para evaluar pacientes con síntomas de obstrucción del tracto de salida. Permite obtener los mismos resultados que la videodefecografía. Es un estudio mínimamente invasivo, evita la exposición a radiación y pone en evidencia todas las estructuras anatómicas involucradas en la evacuación.

Purpose: to describe a novel method to assess Obstructed Defecation Syndrome (ODS) and to show the results of our experience. Material and Methods: patients referred with symptoms of ODS between May 2011 and May 2013 were studied by anorrectal dynamic ultrasonography technique. We use the technique of echodefecography described by Murah-Regadas et al. The test was analyzed by two experienced investigators. Results: we performed 89 echodefecography in 88 patients in a period of 24 months. EDF revealed rectocele in 65%, intussusception in 54% and anismus in 45% of patients. Conclusion: echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorrectal dysfunctions found by defecography. It is a minimally invasive, well tolerated method, that avoids exposure to radiation and clearly shows all the anatomical structures involved in defecation.