Evaluation of functional anorectal disorder by transperineal and three-dimensional endoanal ultrasound

doi:10.3877/cma.j.issn.2095-2015.2022.06.003

Abstract

Abstract:

Objective

To evaluate the diagnostic value of transperineal ultrasound(TPUS)and three-dimensional endoanal ultrasound(3D-EAUS)for functional anorectal disorder(FAD).

Methods

A total of 138 patients with FAD admitted to the Anorectal Department of Nanjing Hospital of Traditional Chinese Medicine from January 2019 to March 2021 were retrospectively analyzed, including 96 cases of functional defecation disorder(FDD), 14 cases of fecal incontinence(FI)and 28 cases of functional anorectal pain(FARP). Bladder neck descent(BND), retrovesical angle(RVA), anorectal angle(ARA), rectocele(RC)were measured by TPUS.Assessment of sphincter integrity and measurement of puborectalis angle were taken using 3D-EAUS.

Results

TPUS: In 80 female patients with FDD, 10(12.5%)patients had BND>25 mm at the maximum Valsalva, 23(28.75%)patients had RVA>140°, 45(56.25%)patients had RC, 43(53.75%)patients had rectal intussusception(RI)and 1(1.25%)patient had enterocele.Among 22 female patients with FARP, 2(9.1%)patients had BND>25 mm at the maximum Valsalva, 4(18.2%)patients had RVA>140°, 11(50%)patients had RC and 13(59.1%)patients had RI.No significant differences were observed in ARA between the resting state and the maximum Valsalva in female patients with FDD and FARP(P>0.05).3D-EAUS: There was a significant difference in the puborectalis angle between the resting state and the maximum Valsalva in 16 male patients with FDD [(88.84±3.80)°vs.(87.54±3.47)°, P<0.05]. In 14 cases of FI, 5 cases had severe sphincter defect(score: 10 to13 points), involving the internal and external sphincter, all of which were perineal laceration caused by birth injury, 1 case of moderate defect(score: 6 points), and 3 cases of mild defect(score: 3 to 4 points). In 41 female patients with FDD, both the ARA and puborectalis angle at the maximum Valsalva were significantly smaller than those at the resting state(P<0.01).

Conclusion

The TPUS and 3D-EAUS can accurately assess the morphological features of the pelvic floor in FAD patients, and detect other accompanying pelvic floor disorders.The assessment is integral.

Key words: Anorectal disorder, Functional defecation disorder, Fecal incontinence, Functional anorectal pain, Transperineal ultrasound, Three-dimensional endoanal ultrasound

Yahong Xue, Fei Liu, Yan Ling, Xiaofeng Wang. Evaluation of functional anorectal disorder by transperineal and three-dimensional endoanal ultrasound[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(06): 334-341.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2022.06.003

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2022/V12/I06/334

Figures/Tables 13

References 39

1	Rao SS，Bharucha AE，Chiarioni G，et al.Functional Anorectal Disorders[J]．Gastroenterology，2016：S0016-5085(16)00175-X.
2	Davis K，Kumar D．Posterior pelvic floor compartment disorders[J]．Best Pract Res Clin Obstet Gynaecol，2005，19(6)：941-958.
3	Drossman DA，Hasler WL.Rome IV-Functional GI Disorders：Disorders of Gut-Brain Interaction[J]．Gastroenterology，2016，150(6)：1257-1261.
4	Schmulson MJ，Drossman DA.What Is New in Rome IV[J]．J Neurogastroenterol Motil.2017；23(2)：151-163.
5	Luber KM，Boero S，Choe JY.The demographics of pelvic floor disorders：current observations and future projections[J]．Am J Obstet Gynecol，2001，184：1496-503.
6	Grossi U，Di Tanna GL，Heinrich H，et al.Systematic review with meta-analysis：defecography should be a first-line diagnostic modality in patients with refractory constipation[J]．Aliment Pharmacol Ther，2018，48(11/12)：1186-1201.
7	Jeong HY，Yang SJ，Cho DH，et al.Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders[J]．Ann Coloproctol，2020，36(4)：256-263.
8	Hainsworth AJ，Solanki D，Hamad A，et al.Integrated total pelvic floor ultrasound in pelvic floor defaecatory dysfunction[J]．Colorectal Dis，2017，19(1)：O54-O65.
9	Vitton V，Vignally P，Barthet M，et al.Dynamic anal endosonography and MRI defecography in diagnosis of pelvic floor disorders：comparison with conventional defecography[J]．Dis Colon Rectum，2011，54(11)：1398-404.
10	AIUM/IUGA Practice Parameter for the Performance of Urogynecological Ultrasound Examinations：Developed in Collaboration with the ACR，the AUGS，the AUA，and the SRU[J]．J Ultrasound Med，2019，38(4)：851-864.
11	Viscardi A，Ratto C，Parello A．Dynamic transperineal ultrasound in the workup of men with obstructed defecation：a pilot study[J]．Dis Colon Rectum，2012，55(9)：976-982.
12	Stafford RE，Ashton-Miller JA，Constantinou CE，et al.A new method to quantify male pelvic floor displacement from 2D transperineal ultrasound images[J]．Urology，2013，81(3)：685-689.
13	Kam HA，Yagel S，Eisenberg VH.Ultrasonography in Pelvic Floor Dysfunction[J]．Obstet Gynecol Clin North Am，2019，46(4)：715-732.
14	Regadas FS，Murad-Regadas SM，Lima DM，et al.Anal canal anatomy showed by three-dimensional anorectal ultrasonography[J]．Surg Endosc，2007，21(12)：2207-2211.
15	Unger CA，Weinstein MM，Pretorius DH.Pelvic floor imaging[J]．Obstet Gynecol Clin North Am，2011，38(1)：23-43.
16	Dietz HP.The role of two-and three-dimensional dynamic ultrasonography in pelvic organ prolapse[J]．J Minim Invasive Gynecol，2010，17(3)：282-294.
17	Chantarasorn V，Dietz HP.Diagnosis of cystocele type by clinical examination and pelvic floor ultrasound[J]．Ultrasound Obstet Gynecol，2012，39(6)：710-714.
18	Wieczorek AP，Stankiewicz A，Santoro GA，et al.Pelvic floor disorders：role of new ultrasonographic techniques[J]．World J Urol，2011，29(5)：615-623.
19	Santoro GA，Wieczorek AP，Dietz HP，et al.State of the art：an integrated approach to pelvic floor ultrasonography[J]．Ultrasound Obstet Gynecol，2011，37(4)：381-396.
20	Dietz HP，Beer-Gabel M．Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation[J]．Ultrasound Obstet Gynecol，2012，40(1)：14-27.
21	Stark M，Bohe M，Valentin L．Effect of vaginal delivery on endosonographic anal sphincter morphology[J]．Eur J Obstet Gynecol Reprod Biol，2007，130：193-201.
22	Murad-Regadas SM，Regadas FS，Rodrigues LV，et al.A novel three-dimensional dynamic anorectal ultrasonography technique(echodefecography)to assess obstructed defecation，a comparison with defecography[J]．Surg Endosc，2008，22(4)：974-979.
23	薛雅红，丁义江，江滨，等．盆底失弛缓综合征患者肛管形态学特征及其与功能的相关性研究[J]．中华胃肠外科杂志，2019，22(5)：457-463.
24	Beer-Gabel M，Carter D．Comparison of dynamic transperineal ultrasound and defecography for the evaluation of pelvic floor disorders[J]．Int J Colorectal Dis，2015，30(6)：835-41.
25	Matthews CA，Whitehead WE，Townsend MK，et al.Risk factors for urinary，fecal，or dual incontinence in the Nurses′ Health Study[J]．Obstet Gynecol，2013，122(3)：539-545.
26	Bliss DZ，Harms S，Garrard JM，et al.Prevalence of incontinence by race and ethnicity of older people admitted to nursing homes[J]．J Am Med Dir Assoc，2013，14(6)：451.e1-e7.
27	Palit S，Thin N，Knowles CH，et al.Diagnostic disagreement between tests of evacuatory function：a prospective study of 100 constipated patients[J]．Neurogastroenterol Motil，2016，28(10)：1589-1598.
28	Tirumanisetty P，Prichard D，Fletcher JG，et al.Normal values for assessment of anal sphincter morphology，anorectal motion，and pelvic organ prolapse with MRI in healthy women[J]．Neurogastroenterol Motil，2018，30(7)：e13314.
29	Steensma AB，Oom DM，Burger CW，et al.Assessment of posterior compartment prolapse：a comparison of evacuation proctography and 3D transperineal ultrasound[J]．Colorectal Dis，2010，12(6)：533-539.
30	Regadas FS，Haas EM，Abbas MA，et al.Prospective multicenter trial comparing echodefecography with defecography in the assessment of anorectal dysfunction in patients with obstructed defecation[J]．Dis Colon Rectum，2011，54(6)：686-692.
31	van Gruting IMA, Stankiewicz A, Kluivers K, et al.Accuracy of Four Imaging Techniques for Diagnosis of Posterior Pelvic Floor Disorders[J]．Obstet Gynecol，2017，130(5)：1017-1024.
32	Albuquerque A，Pereira E．Current applications of transperineal ultrasound in gastroenterology[J]．World J Radiol，2016，8(4)：370-377.
33	陆继红，李茜，朱红，等．超声测量膀胱尿道后角对诊断压力性尿失禁的临床价值[J]．中华妇产科杂志，2010，45(5)：338-341.
34	薛雅红，丁曙晴，丁义江．动态经会阴超声评估女性慢性肛门痛盆底形态学特征[J]．中华超声影像学杂志.2016，25(11)：984-989.
35	Xue YH，Ding SQ，Ding YJ，et al.Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia[J]．World J Gastroenterol，2017，23(21)：3900-3906.
36	De Leeuw JW，Vierhout ME，Struijk PC，et al.Anal sphincter damage after vaginal delivery：functional outcome and risk factors for fecal incontinence[J]．Acta Obstet Gynecol Scand，2001，80(9)：830-834.
37	Etienney I，de Parades V．Three-dimensional endoanal ultrasonography in daily proctological practice[J]．Clin Res Hepatol Gastroenterol，2011，35(4)：260-270.
38	Volløyhaug I，Taithongchai A，Arendsen L，et al.Is endoanal，introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence? [J]．Int Urogynecol J，2020，31(7)：1471-1478.
39	Taithongchai A，van Gruting IMA，Volløyhaug I，et al.Comparing the diagnostic accuracy of 3 ultrasound modalities for diagnosing obstetric anal sphincter injuries[J]．Am J Obstet Gynecol，2019，221(2)：134.e1-134.e9.

组别	例数	女性/男性[例(%)]	年龄(岁，±s)	病程(月，±s)	严重度评分(±s)
组别	例数	女性/男性[例(%)]	年龄(岁，±s)	病程(月，±s)	CCF-FIS	CSS	VAS
大便失禁	14	11(78.6)/3(21.4)	48±15.20	61.71±100.13	11±3.94	－	－
功能性肛门直肠痛	28	22(78.6)/6(21.4)	51.75±11.55	51.61±77.34	－	－	8±1.28
功能性排便障碍	96	80(83.3)/16(16.7)	51.84±13.01	80.24±64.41	－	15.89±2.50	－
组别	例数	伴随其他疾病[例(%)]		手术及外伤史[例(%)]
组别	例数	压力性尿失禁	抑郁症	痔切除术	括约肌松解术	子宫切除术	产伤致会阴撕裂	车祸致肛门外伤
大便失禁	14	0	0	0	1(7.1)	0	6(42.8)	3(21.4)
功能性肛门直肠痛	28	1(3.6)	1(3.6)	1(3.6)	0	2(7.2)	0	0
功能性排便障碍	96	5(5.2)	0	0	0	2(2.1)	0	0

组别	例数	女性/男性[例(%)]	年龄(岁，±s)	病程(月，±s)	严重度评分(±s)
组别	例数	女性/男性[例(%)]	年龄(岁，±s)	病程(月，±s)	CCF-FIS	CSS	VAS
大便失禁	14	11(78.6)/3(21.4)	48±15.20	61.71±100.13	11±3.94	－	－
功能性肛门直肠痛	28	22(78.6)/6(21.4)	51.75±11.55	51.61±77.34	－	－	8±1.28
功能性排便障碍	96	80(83.3)/16(16.7)	51.84±13.01	80.24±64.41	－	15.89±2.50	－
组别	例数	伴随其他疾病[例(%)]		手术及外伤史[例(%)]
组别	例数	压力性尿失禁	抑郁症	痔切除术	括约肌松解术	子宫切除术	产伤致会阴撕裂	车祸致肛门外伤
大便失禁	14	0	0	0	1(7.1)	0	6(42.8)	3(21.4)
功能性肛门直肠痛	28	1(3.6)	1(3.6)	1(3.6)	0	2(7.2)	0	0
功能性排便障碍	96	5(5.2)	0	0	0	2(2.1)	0	0

缺损范围		评分
缺损范围		0	1	2	3
外括约肌
	长度	无	≤50%	>50%	完全
	厚度	无	部分	全部	－
	范围	无	≤90°	91~180°	>180°
内括约肌
	长度	无	≤50%	>50%	完全
	厚度	无	部分	全部	－
	范围	无	≤90°	91~180°	>180°

缺损范围		评分
缺损范围		0	1	2	3
外括约肌
	长度	无	≤50%	>50%	完全
	厚度	无	部分	全部	－
	范围	无	≤90°	91~180°	>180°
内括约肌
	长度	无	≤50%	>50%	完全
	厚度	无	部分	全部	－
	范围	无	≤90°	91~180°	>180°

组别	例数	BSD			RVA
组别	例数	静息状态(mm，±s)	最大Valsalva(mm，±s)	最大ValsalvaBND>25 mm[例(%)]	静息状态(±s)	最大Valsalva(±s)	最大ValsalvaRVA>140°[例(%)]
FDD	80	26.30±4.01	12.68±9.66	10(12.50)	126.42°±22.59°	126.30°±25.81°	23(28.75)
FARP	22	25.59±3.73	14.48±8.46	2(9.09)	122.05°±22.72°	108.54°±32.56°	4(18.18)
组别	例数	肛直角		最大Valsalva时其他表现
组别	例数	静息状态(±s)	最大Valsalva (±s)	RC[例(%)]	RC(mm，±s)	RI[例(%)]	肠疝[例(%)]
FDD	80	122.04° ±9.99°	120.05°±13.45°^▲	45(56.25)	14.17±3.12	43(53.75)	1(1.25)
FARP	22	120.05° ±7.71°	120.55° ±10.64°^▲	11(50)	14.72±3.90	13(59.09)	0

Please choose a citation manager

Content to export