A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation, a comparison with defecography.

AIM

To test the effectiveness of echodefecography, the dynamic 3D anorectal ultrasonography technique -(EDF). To assess women with obstructed defecation (OD), as compared with conventional defecography (DF).

METHODS

A prospective study was carried out with 30 women with OD symptoms, the mean validated Wexner constipation score was 14 (range 7-25) and the mean age 47.7 years. All patients were submitted to DF followed by EDF and the results compared.

RESULTS

Six patients were normal at DF and five were normal at EDF. Defecography identified grade I rectocele in five patients (average size: 1.8 cm), grade II in seven (average size: 2.9 cm) and grade III in 12 (average size: 4.6 cm). Different sizes of anorectocele were also observed at EDF and quantified according to DF classification (grade I: </=0.6 cm; grade II: 0.7-1.3 cm; grade III: >1.3 cm). Significant differences were observed between anorectocele sizes (p < 0.05) and between normal patients and grade I (p < 0.001). The level of agreement between the techniques was high (kappa = 0.902), with only one normal case wrongly identified as anorectocele III at EDF. Rectal intussusception was identified in five patients at DF; EDF confirmed these cases and revealed seven others, demonstrating moderate agreement (kappa = 0.462). Anismus was identified in nine patients in DF and in eight in EDF (kappa = 0.901).

CONCLUSION

Echodefecography may be used as an alternative method to assess patients with OD as it has been shown to detect the same anorectal dysfunctions observed in DF. It is minimally invasive, well tolerated, inexpensive, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved with defecation.