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Ultrasound Indicators of Rectal Support Defect in Women With Obstructive Defecatory Symptoms

Rostaminia, Ghazaleh, MD, MSc*†; Javadian, Pouya, MD; Awad, Charbel, MD; Shobeiri, S. Abbas, MD, MBA

Female Pelvic Medicine & Reconstructive Surgery: May/June 2019 - Volume 25 - Issue 3 - p 222–225
doi: 10.1097/SPV.0000000000000511
Original Articles
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Objective The anatomic and physiologic pathophysiology of obstructive defecatory symptoms is complex and poorly understood. As a consequence, there is no one surgical method that can achieve overall superiority. We aimed to investigate rectal architectural change in women with obstructive defecatory symptoms using three-dimensional pelvic floor ultrasound.

Methods This retrospective cohort study included 65 women who were referred to our urogynecology clinic because of varied pelvic floor disorders between January 2013 and January 2014. Patients completed a standardized interview including PFDI-20 questionnaire and received a standard examination and assessment of pelvic floor by three-dimensional endovaginal ultrasound. Women were categorized to case and control based on their answers to questions 7, 8, and 14 on PFDI-20 (Colorectal and Anal Distress Index) questionnaire. In ultrasound images, levator plate descent angle, levator plate-probe distance, and rectal area have been measured and values have been compared among symptomatic and asymptomatic patients.

Results Forty-five women with obstructive defecatory symptoms and 20 asymptomatic women entered the study. There was no significant difference in mean (SD) age (56.55 [SD] 13.29 vs 51.8 [15], P = 0.2), mean (SD) body mass index (27.39 [6.7] vs 24.2 [4.08], P = 0.11), and median (range) parity (3 [1–7] vs 2 [1–6], P = 0.15) among categories. There was significant difference in ultrasound measurements, levator plate descent angle, levator plate-probe distance, and rectal area, between women with obstructive defecatory symptoms and asymptomatic women.

Conclusions Women with obstructive defecatory symptoms have wider rectum and descendent levator plate regardless of the stage of prolapse as measured by POPQ or the severity of rectocele.

Women with obstructive defecatory symptoms have wider rectum and descendent levator plate regardless of the prolapse stage as measured by POPQ or the severity of rectocele.

From the *Northshore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL;

Department of Obstetrics and Gynecology, Virginia Commonwealth University INOVA Fairfax Campus, Falls Church, VA; and

Department of Obstetrics and Gynecology, Newark Beth Israel Medical Center, Newark, NJ.

Correspondence: S. Abbas Shobeiri, MD, MBA. INOVA Women’s Hospital, Dept of OB/GYN, 3300 Gallows Rd. 2nd floor, South tower. Falls Church, VA. 22043. E-mail: Abbas.Shobeiri@INOVA.org.

This manuscript was conceived of, designed, IRB approved, performed, analyzed and written while the senior author was at the University of Oklahoma.

The authors have declared they have no conflicts of interest.

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