title: Detection of anal sphincter defects in female patients with fecal incontinence:  a comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound.
abstract: BACKGROUND
  Endoanal ultrasound is widely used for the detection of external and internal anal sphincter defects in patients with fecal incontinence. Recently, 3-dimensional transperineal ultrasound has been introduced as a noninvasive imaging method for the detection of these sphincter defects.
  
  
  OBJECTIVE
  This study was designed to assess agreement between 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound regarding the detection of anal sphincter defects in women with fecal incontinence.
  
  
  METHODS
  This study was designed as a prospective observational study.
  
  
  METHODS
  The study took place in a university hospital.
  
  
  METHODS
  Between October 2008 and June 2009, all women with concerns of fecal incontinence underwent 2-dimensional endoanal ultrasound as well as 3-dimensional transperineal ultrasound.
  
  
  METHODS
  The main outcome measures are the presence of external and internal anal sphincter defects.
  
  
  RESULTS
  Fifty-five patients were included. External and internal anal sphincter defects were observed with 2-dimensional endoanal ultrasound in 27 (49%) and 15 (27%) patients. Three-dimensional transperineal ultrasound detected an external and internal sphincter defect in 19 (35%) and 16 (29%) patients. The Cohen κ coefficient for the detection of external (κ = 0.63) and internal (κ = 0.78) anal sphincter defects was good.
  
  
  CONCLUSIONS
  This study's limitations include the absence of a surgical examination as the reference standard in the determination of sphincter defects.
  
  
  CONCLUSIONS
  This study shows good agreement between 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound regarding the detection of anal sphincter defects. Based on these data, 3-dimensional transperineal ultrasound might be considered as a valuable alternative noninvasive investigation method.
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Daniëlla M J
authors.initials: DM
authors.lastname: Oom
authors.forename: Rachel L
authors.initials: RL
authors.lastname: West
authors.forename: W Rudolph
authors.initials: WR
authors.lastname: Schouten
authors.forename: Anneke B
authors.initials: AB
authors.lastname: Steensma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects; D019160:Endosonography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires