Biomedical subjects

L J Rivela

Publications and source records attributed to L J Rivela.

3 recordsLinked to original sources

PubMed1997

Diagnosing anal sphincter injury with transanal ultrasound and manometry.

PURPOSE: This study was undertaken to evaluate how well anorectal manometry and transanal ultrasonography diagnose anal sphincter injury. METHODS: Anorectal manometry and transanal ultrasonography were performed in 20 asymptomatic nulliparous women and 20 asymptomatic parous women, and the results were compared with those obtained in 31 incontinent women who subsequently underwent sphincteroplasty and, thus, had operatively verified anal sphincter injury. By using computerized manometry analysis, mean maximum resting and squeeze pressures, sphincter length, and vector symmetry were determined in all women. All transanal ultrasounds were interpreted blinded as to the patient's history, physical examination, and manometry results. RESULTS: Manometric resting and squeeze pressures were significantly higher in the asymptomatic nulliparous women than in the asymptomatic parous women, and both groups had significantly higher pressures than the incontinent women (P < 0.001). Anal sphincter length and vector symmetry index were significantly decreased in incontinent women compared with asymptomatic women (P < 0.01). Decreased resting and squeeze pressures suggestive of possible sphincter injury were found in 90 percent of incontinent women with known anal sphincter injury. Decreased anal sphincter length and vector symmetry were found in only 42 percent of women with known anal sphincter injury. Transanal ultrasound was able to identify 100 percent of the known sphincter injuries but also falsely diagnosed injury in 10 percent of the asymptomatic nulliparous women with intact anal sphincters. False identification of sphincter injury increased when transanal ultrasound scanning was performed proximal to the distal 1.5 cm of the anal canal. CONCLUSION: Although nonspecific, decreased resting and squeeze pressures were found in 90 percent of patients with anal sphincter injury. Decreased anal sphincter length or vector symmetry index were present in only 42 percent of patients with known sphincter injury. When limited to the distal 1.5 cm of the anal canal, transanal ultrasound identified all known sphincter injuries but falsely identified injury in 10 percent of women with intact anal sphincters. Transanal ultrasound in combination with decreased anal pressures correctly identified all intact sphincters and 90 percent of known anal sphincter injuries.

Adult↗

PubMed1995

Simultaneous dynamic proctography and peritoneography for pelvic floor disorders.

PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/prolapse, and/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied. CONCLUSION: Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.

Adult↗

PubMed1995

Patterns of male fecal incontinence.

PURPOSE: This study sought to identify clinical and manometric characteristics of male fecal incontinence. METHOD: Clinical charts of 25 men with a chief complaint of fecal incontinence were retrospectively reviewed. Their anorectal physiology test results were compared with those from a group of 20 healthy men. RESULTS: Fourteen men (56 percent) were "leakers," who complained of loss of liquid or solid stool smears that stained their underclothes. Eleven men (44 percent) had true incontinence, with loss of control over gas, liquid, and/or solid stool. Leakers had lower anal sphincter pressures than normal men (P < 0.05) but higher pressures than incontinent men (P < 0.05). In leakers the anal sphincter length at rest was longer than in incontinent (P < 0.01) and normal men (P < 0.05). All incontinent men had decreased manometric pressures, abnormal anorectal sensation or prolonged pudendal nerve terminal motor latencies, whereas only one-half of the leakers had physiologic abnormalities. Treatment using dietary manipulation, constipating agents or cleansing enemas was successful in nearly 90 percent of incontinent men but only 55 percent of the leakers. CONCLUSIONS: Whereas true incontinence in men is caused by a short, low pressure sphincter with altered sensation or innervation, leakage is associated with a long, intermediate pressure sphincter that frequently has normal sensation and innervation. This long, intermediate pressure sphincter may predispose these men to leakage. Treatment of leakers is less successful than treatment of incontinent men. Leakers and incontinent men have unique clinical and physiologic profiles that should be identified to help guide treatment and determine prognosis.

Adult↗