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PubMedDate not supplied

[Enterocele: clinical risk factors and association with others pelvic floor disorders (about 544 defecographies)].

OBJECTIVE: To study, by means of defecography, clinical risk factors of enterocele and association with others pelvic floor disorders. PATIENTS AND METHODS: Five hundred and forty-four consecutive female patients were investigated by colpocystodefecography with contrast medium in the small bowel. One hundred and thirty-six women with enterocele were compared to 408 women without enterocele. RESULTS: There were no significant differences in age, obstetrical history (parity, foetal macrosomia, instrumental extractions or perineal tear to delivery) between the two groups. More women with enteroceles had histories of hysterectomies (60% versus 24%) or cystopexies (29% versus 13%). Others pelvic floor disorders were associated in 91% of enterocele: rectocele (25%), cystocele (42%), uterine prolapse (28%), rectal intussusception (52%), rectal prolapse (4%) and abnormal perineal descent (30%). Stress urinary incontinence was significantly more frequent in women without enterocele. DISCUSSION AND CONCLUSIONS: The study has demonstrated that previous hysterectomy and cystopexy increased the risk of enterocele formation and that enterocele and others pelvic floor disorders are often concomitant. Enterocele may have a pessary effect on urinary disorders. Results of colpocystodefecography reinforce the notion of pelvic floor local disease.

Adult↗
PubMed1994

Reproducibility of five anorectal morphologic measurements in defecography.

RATIONALE AND OBJECTIVES: We evaluated the inter- and intraobserver reproducibility of measuring five morphologic parameters of the anorectum in defecography (evacuation proctography). METHODS: Measurements from 42 defecographic studies were statistically analyzed. The parameters measured during resting, squeezing, and straining included two anorectal angles (posterior and axis), maximal width of the anal canal, maximal width of the rectal lumen, and size of the rectocele. RESULTS: The results demonstrated only fair interobserver agreement (kappa = 0.22-0.38) for almost all measurements of the five morphologic parameters. There were high correlations (kappa = 0.62-1.00) among most intraobserver measurements. CONCLUSION: For defecographic measurement, the five parameters we studied have relatively poor clinical value because of high inter- and intraobserver inconsistency.

Adult↗
PubMed2001

[Dynamic MR defecography for diagnosis of combined functional disorders of the pelvic floor in proctology].

PURPOSE: Evaluation of magnetic resonance defecography in the diagnosis of pelvic floor disorders were examined prospectively. MRI was performed on a 1.5 T scanner. The rectum was opacified with 200 ml of ultrasound transmission gel. A sagittal single section T2-weighted gradient echo sequence with a temporal resolution of 1.1 second was performed. Changes of the anorectal angle and the position of the pelvic organs in relation to the pubococcygeal line were registered at rest, during straining, and during evacuation of the rectum. RESULTS: Patients with obstructed defecation (n = 15) showed prolapse of the rectal mucosa (n = 5), anterior rectocele (n = 8), pelvic floor descent (n = 5), enterocele (n = 2), and anorectal dyscoordination (n = 3). Individuals with stool incontinence (n = 15) had an anterior rectocele (n = 10), pelvic floor descent (n = 11), enterocele (n = 2), prolapse of rectal mucosa (n = 1), and a puborectal insufficiency (n = 1). Urine incontinence was associated with cystocele (n = 10) or normal findings (n = 4). In patients with unspecific symptoms (n = 6), anorectal dyscoordination (n = 4) and prolapse of the rectal mucosa (n = 2) were found. MRI was superior for the detection of enteroceles, cystoceles and pelvic floor descent compared with clinical investigation. CONCLUSION: Dynamic MR imaging supplies complex information in anorectal disease and thus improves proctoscopy.

Adolescent↗
PubMed2006

A prospective comparison between clinical outcome and open-configuration magnetic resonance defecography findings before and after surgery for symptomatic rectocele.

BACKGROUND: The correlation between clinical symptoms and anatomical findings by conventional imaging is poor in patients with rectoceles. The aim of this prospective study was to assess and to correlate symptomatic changes after anterior levatorplasty with morphologic changes visualized by magnetic resonance defecography (MRD). METHOD: Fourteen women with a median age of 57 (range 37-83) accepted to participate. Seven of 14 had previous hysterectomy. Patients underwent MRD before surgery and again 6 months postsurgery. Pre- and postoperative symptoms and quality of life (QoL) (Eypasch) were assessed. Faecal and urinary incontinence were graded (Wexner- / Hanley-score). RESULTS: The median Eypasch-score improved from 90 (range 38-106) to 106 (range 29-133) after surgery (P = 0.016). Similarly, the Wexner-score ameliorated from 8 (range 0-20) to 4.5 (range 0-18; P = 0.02). Seven patients described new dyspareunia postoperatively. The median follow up was 16.5 months (range 9-45). The median rectocele size decreased from 37 mm (range 30-48) preoperatively to 12 mm (range 0-42) postoperatively (P = 0.004). Furthermore, enteroceles were corrected and pelvic floor descent was significantly reduced after surgery. Only the clinical symptom of incomplete evacuation strongly correlated with the respective radiological finding of contrast dye trapping (Rho = 0.822; P = 0.001). CONCLUSION: Anterior levatorplasty improved QoL in patients with symptomatic rectocele. Postsurgical correction of rectocele is accurately documented by MRD. Only moderate correlation between morphologic and clinical improvements was observed.

Adult↗
PubMed1999

[Our concept of defecography. Methods and reproducibility of results].

Defecography is used in the Czech Republic only exceptionally. Since 1988 the authors made 402 defecographic examinations. They submit a detailed description of hitherto assembled experience and their own modification of the examination. As contrast material they use at present Micropaque susp. thickened by means of wheat bran. They administer it by means of a modified press for dough preparation. The X-rays are taken on a modified ordinary stool made from soft timber. For screening of uncovered places in the visual field they use individually placed copper plates 2 mm thick. For better evaluation of the X-rays the authors place during examination an X-ray contrasting net behind the patient. Pictures are taken at rest, during contraction, during modified Valsalva's manoeuvre and during all stages of defecation. The authors mention the most interesting pathological pictures they encountered so far--internal prolapse, levator hernia, rectocele, sphincter defect, various forms of prolapses and dyskineses of the pelvic floor. In the authors opinion the basic quantifiable parameters are the magnitude of the anorectal angles. They used the assessment method described by Mahieu, as well as the mediorectal angle which in their opinion is a reflection of the patient's somatotype and levator function. More than the absolute values of the angles they emphasize the difference of the two angles and change of the latter during contraction and defecation. In their opinion enlargement of the difference during contraction and diminution to values close to zero is normal. Converse values are according to the authors evidence of dyssynergy of the pelvic floor. Independent assessment of the angles and magnitude of the lift of the pelvic floor by three subjects are subjected to statistical analysis. They provide evidence of complete reproducibility of results of anorectal angles according to the authors' definition. The results of assessment can be used to investigate relations with parameters of anorectal manometry (AM) or transrectal sonographyy (TRS) in subsequent investigations.

Contrast Media↗
PubMed1984

Defecography: I. Description of a new procedure and results in normal patients.

To solve frequently encountered clinical problems in the anorectal area, we have developed a simplified dynamic method of defecography. A radiopaque substance, the consistency of normal stools, is introduced into the rectum and the patient is then seated on a specially designed seat composed of superposed air chambers which, for technical reasons, are filled with water. The movements induced by evacuation of the rectum are recorded using 100-mm ampliphotography. After recording findings in 56 normal patients, we are able to define 5 criteria for "normal": increase in anorectal angulation, obliteration of the impression of the puborectal muscle, wide opening of the anal canal, total evacuation of the rectal contents, and normal resistance of the pelvic floor. The mean value of the anorectal angle (ARA) was 91.96 degrees (+/- 1.52 SEM) at rest and 136.76 degrees (+/- 1.51 SEM) during straining. The increase of ARA during straining is 44.8 degrees.

Adolescent↗
PubMed1984

Defecography: II. Contribution to the diagnosis of defecation disorders.

Our simple method of defecography has proved to be more sensitive than clinical evaluation in the detection and description of defecation disorders. Among the different types of disorders, described on the basis of 144 abnormal defecograms, the most common are rectal intussusception (RI), intraanal rectal intussusception (IRI), external manually (EMRP) or spontaneously (ESRP) reducible prolapses, rectocele, and accentuation of the impression of the puborectalis sling (AIPR). Study of the mean values of the anorectal angle (ARA) (normal mean value = 92 degrees at rest) reveals an increase (p less than 0.05) in the ARA in IRI and ESRP and a decrease (p less than 0.05 at rest, p less than 0.001 at strain) in AIPR. The most striking observation is a highly significant increase (p less than 0.001) in the ARA associated with incontinence.

Adolescent↗
PubMed1992

Is the volume retained after defecation a valuable parameter at defecography?

The intention of this study was to correlate the retained volume at the end of defecography to certain defecographic findings and to the sense of incomplete emptying. In 170 defecographic series, the retained barium was estimated planimetrically. No particular defecographic finding determined a higher or lower amount of remaining volume, and the sense of incomplete evacuation did not depend on the amount of retained volume. Thresholds of urge and perception on anorectal manometry did not differ between patients with and without the feeling of incomplete evacuation. A rectocele, isolated or combined with an internal prolapse, caused the retained volume to be in the lowermost part of the rectum, whereas, in the case of an isolated intussusception, the remaining volume was located in the middle or higher part of the rectum. It is concluded that defecographic findings do not in general explain incomplete emptying or the sense of incomplete emptying, but they may determine the localization of the retained volume.

Adult↗
PubMed1996

Defecography and proctography. Results of 744 patients.

PURPOSE: Radiographic imaging of dynamic changes within the pelvic cavity and rectum during evacuation has been recognized as a valuable method of assessment. This study was designed to assess the incidence and clinical significance of defecographic findings in patients with possible evacuation disorders. MATERIALS AND METHODS: All defecographic studies were reviewed by a single colorectal surgeon familiar with patients' histories and physical findings. RESULTS: Between July 1988 and July 1995, 744 patients (566 females and 178 males) with a mean age of 63.5 (range, 12-95) years had defecographic and proctographic examination. Four hundred forty-six (60 percent) patients were diagnosed who complained of constipation, 123 (16.5 percent) of fecal incontinence, 42 (5.6 percent) of rectal prolapse, 82 (11 percent) of rectal pain, and 51 (6.9 percent) had a combination of more than one of these diagnoses. Although 93 (12.5 percent) of these evaluations were considered normal, 61 (8 percent) revealed rectal prolapse, 191 (25.7 percent) rectocele, 82 (11 percent) sigmoidocele, and 94 (12.6 percent) intussusception; in 223 (30 percent) patients, a combination of these findings was noted. Patients with paradoxical puborectalis contraction had an extremely high frequency of constipation compared with other symptoms (P < 0.0001). CONCLUSIONS: Defecography can reveal abnormalities in the majority of patients with evacuatory disorders. There was a high incidence of rectocele, sigmoidocele, and intussusception. Care must be taken not to treat patients strictly based on radiographic findings.

Aged↗
PubMed1999

Measurement of the anorectal angle by defecography for the diagnosis of fecal incontinence.

We assessed the reliability of anorectal angle (ARA) measurement as an index of fecal incontinence. The "posterior" ARA was measured at rest, squeezing, and straining in 69 continent and 82 incontinent subjects all complaining of various evacuation dysfunctions. The two groups were homogeneous with regard to sex distribution (48.6% vs. 51.4% men and 44.7% vs. 55.3% women, n.s.) and age (56.5 +/- 10.2 vs. 59.3 +/- 9.7 years, n.s.). The incidence of rectal prolapse was the same in the two groups (40 each). The intraobserver agreement index from two independent measurements (Pearson's correlation coefficient), age, and gender interaction [T2 Hotelling test in multivariate analysis of variance (ANOVA)] and the most discriminating category of ARA measurement (Fisher's F test in ANOVA) were calculated. In addition, the relationship between ARA and severity of incontinence was assessed by the eta coefficient. Pearson's correlation coefficient was between 0.78 and 0.98 (P < 0.01). The mean ARA differed significantly between the continent and incontinent subjects (104.5 +/- 10.3 degrees vs. 116.2 +/- 23.6 degrees at rest, 84.5 +/- 14.2 degrees vs. 95.1 +/- 20.1 degrees on squeezing, and 133.7 +/- 21.7 degrees vs. 141.7 +/- 25.9 degrees on straining; T2 0.066, P < 0.05 in multivariate ANOVA). No interaction was noted between groups and gender (T2 = 0.023; F = 1.11, n.s.). Resting ARA was shown by ANOVA to be the most discriminating index (F = 9.4 P < 0.01) between the two groups. Overall, ARA measurement was correlated with the severity of fecal incontinence (eta coefficient: 0.894 at rest; 0.811 on squeezing; 0.695 on straining); its accuracy was 79%, the false-positive rate was 15.3% and the false-negative rate 26.5%. Irrespective of the underlying abnormality, namely rectal prolapse, ARA measurement by defecography can: (a) be reinterpreted reliably by the same observer and (b) differentiate continent from incontinent subjects.

Adolescent↗
PubMed1990

Evacuation proctography (defecography). A new seat and method of examination.

A new evacuation proctography (defecography) seat and method of examination is described. The seat was constructed in association with the department of biotechnology. It is constructed of perspex and radiographic demonstration of the distal rectum and anal canal region is obtained without distracting artefacts.

Anal Canal↗
PubMed1988

Functional analysis of anorectal junction: defecography.

The radiograms and videotape recordings from 32 defecographies in patients with defecation complaints were retrospectively analyzed. The patients had been examined in an upright position during stooling of a barium contrast medium. All patients had had a double contrast colon examinations which was normal. Internal procidentia was found in 20 patients, enterocele in 9 patients, proctocele in 10 patients, a defective opening of the anorectal junction which was ascribed to incoordination of the puborectal sling was present in 15 patients. Most patients had a variety of concomitant dysfunctions.

Adult↗
PubMed1991

Defecography as part of the evaluation of anorectal dysfunction.

Defecography is the evaluation of the anus and rectum during the act of defecation. We have devised a very simple method of performing this examination in conjunction with the Radiology Department. The entire procedure takes less than 15 minutes from start to finish. In our hospital, we have performed over 130 of these tests. A high level of patient cooperation has been noted in our experience. For the most part, the entire procedure from bowel preparation to final films is well tolerated.

Barium Sulfate↗
PubMed1988

Defecography commode.

A mobile wooden commode was designed and built for use in defecography. The commode is made of 1/2-inch-thick plywood with birch veneer and a solid clear pine seat. Water or copper sheets are recommended for radiation filtration. A radiopaque ruler attached to the commode with a spring enables midline measurements. The modifications suggested by the authors have helped with setup and have improved the images acquired.

Humans↗
PubMed1992

Contrast medium gel for marking vaginal position during defecography.

A tampon soaked with contrast medium, which had been inserted into the vagina as part of standard defecography procedure, obscured signs of anterior rectocele and rectal intussusception in a 34-year-old woman. A contrast medium gel for marking vaginal position was formulated, and postsurgical examination with use of the gel revealed improved rectal function and no intussusception. The gel provided excellent contrast without obscuring important diagnostic information.

Adult↗
PubMedDate not supplied

Defecography: techniques for improved image quality.

Defecography is a radiographic study that demonstrates the physiological process involved when the rectum evacuates. Fluoroscopy, video recording and spot films are used to record the sequence of events that occur during defecation. Proper radiographic techniques and procedures must be used to demonstrate pathological conditions such as rectoceles, rectal intussusception and prolapse of the rectum.

Defecation↗
PubMed1983

[Value and limits of defecography in childhood].

The experience about 73 defecographic exams performed in pediatric age is reported. The casuistry is critically analyzed, taking into consideration the most recent non radiological diagnostic improvements. In the authors' opinion, defecography in pediatric age is advisable in the diagnosis and post-operative control of fecal incontinence. In the other cases radiology may be substituted by other less invasive and sometimes more precise methods.

Child↗