Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms.
BACKGROUND
Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures.


OBJECTIVE
The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor.


METHODS
This was a prospective study.


METHODS
The study was conducted at a large university tertiary care hospital.


METHODS
Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale.


METHODS
Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction.


METHODS
Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm.


RESULTS
Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1-1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0-2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus).


CONCLUSIONS
The study did not include a control group without symptoms.


CONCLUSIONS
Three-dimensional endovaginal ultrasonography is a reliable technique for assessment of perineal descent. Using this technique, excessive perineal descent can be defined as displacement of the anorectal junction >1 cm and/or its position below the symphysis pubis on Valsalva maneuver.
1 Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil 2 Unit of Pelvic Floor and Anorectal Physiology, Clinical Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil 3 Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil.
Sthela M
SM
Murad-Regadas
Francisco Sergio
FS
Pinheiro Regadas
Lusmar V
LV
Rodrigues
Adjra
A
da Silva Vilarinho
Guilherme
G
Buchen
Livia Olinda
LO
Borges
Lara B
LB
Veras
Mariana Murad
MM
da Cruz
D000368:Aged; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D019841:Defecography / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D010502:Perineum / Q000000981:diagnostic imaging / Q000503:physiopathology; D020047:Rectocele / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D013223:Statistics as Topic; D014463:Ultrasonography / Q000379:methods