Endosonography in the evaluation of anal function after primary repair of a third-degree obstetric tear.
BACKGROUND
Disruption of the anal sphincter occurs in 0.6%-6% of women during delivery and almost half have persistent defecatory symptoms despite primary repair. Our aim was to prospectively analyse anal endosonography and rectoanal manometry after primary repair of a third-degree obstetric tear in order to compare the findings with the clinical outcome.


METHODS
Twenty-one women aged 27-41 (mean 31.5 years) who had undergone primary suture of a third-degree disruption of the anal sphincter were interviewed on their pelvic floor function and explored by manometry and endosonography 4 months after delivery.


RESULTS
Twelve women had anal incontinence. External sphincter defect was identified on endosonography in 22% continent and in 91% incontinent women (P < 0.01). The presence of an external sphincter defect was associated with anal incontinence in 91.7%. Surgical repair was identified on endosonography in 88% continent women and in 25% incontinent women (P < 0.03). The combination of a visible surgical repair and absence of defect was highly associated with normal continence (91.7%). Squeezing pressures were higher in continent women (87 +/- 23 cm H2O) than in incontinent women (48 +/- 36 cm H2O; P = 0.04), but no anal pressure threshold could achieve better results than endosonography in predicting the clinical outcome.


CONCLUSIONS
After primary repair of a third-degree obstetric tear, endosonographic pattern of the anal sphincter correlates with the continence status.
Savoye-Collet
C
C
Dept. of Radiology, Research Unit QUANT-IF, Rouen University Hospital, Rouen, France. savoyecel@hotmail.com
Savoye
G
G
Koning
E
E
Sassi
A
A
Leroi
A M
AM
Dacher
J N
JN
D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D036861:Delivery, Obstetric / Q000009:adverse effects*; D019160:Endosonography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008365:Manometry; D008429:Maternal Welfare; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D012421:Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index; D013536:Suture Techniques; D016896:Treatment Outcome