Can we use integrated total pelvic floor ultrasound as a screening tool in defaecatory pelvic floor dysfunction? A prospective evaluation of the accuracy of integrated total pelvic floor ultrasound compared with defaecation proctography

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-02-13 DOI:10.1111/codi.17274

Charlotte Ralston, Max Reena, Deepa Solanki, Samantha Morris, Alexis M. P. Schizas, Andrew B. Williams, Alison J. Hainsworth

{"title":"Can we use integrated total pelvic floor ultrasound as a screening tool in defaecatory pelvic floor dysfunction? A prospective evaluation of the accuracy of integrated total pelvic floor ultrasound compared with defaecation proctography","authors":"Charlotte Ralston, Max Reena, Deepa Solanki, Samantha Morris, Alexis M. P. Schizas, Andrew B. Williams, Alison J. Hainsworth","doi":"10.1111/codi.17274","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>Pelvic floor dysfunction is common and includes symptoms such as urinary incontinence, pelvic pain, faecal incontinence, obstructive defaecation syndrome symptoms and pelvic organ prolapse. It is investigated with defaecation proctography (DP) and integrated total pelvic floor ultrasound (TPFUS). Whilst DP is currently the gold standard, TPFUS is efficient and less invasive, offering additional sphincter function assessment. This study aimed to compare TPFUS accuracy to DP in the evaluation of pelvic floor dysfunction.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>From 2015 to 2016, a prospective observational study was conducted at Guy's and St Thomas's Foundation Trust. Symptomatic women with incomplete evacuation were consecutively invited to participate. Patients underwent three scans using both TPFUS and DP. Reports were independently verified by a blinded consultant. Sensitivity, specificity and agreement were calculated for anatomical (rectocele, intussusception, enterocele, cystocele) and functional (coordination, evacuation) features.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 216 patients were included. Moderate agreement was seen between DP and TPFUS in prediction of rectoceles (positive predictive value 85%, negative predictive value 67%, Cohen's kappa 0.46) and on the evaluation of dimensions of rectoceles (<i>R</i> coefficient 0.55) (<i>P</i> < 0.0001). Fair agreement was seen in the assessment of propulsion (positive predictive value 76%, negative predictive value 50%, Cohen's kappa 0.25). Poor agreement was observed on other anatomical and functional objectives.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This is the most extensive prospective comparison of these imaging modalities. While there is limited correlation between DP and TPFUS in exploring anatomical and functional aspects of pelvic floor disorders, TPFUS proves to be an effective screening tool. With enhanced expertise and confidence in its use, TPFUS could potentially guide surgical planning rather than solely identifying those needing DP.</p>\n </section>\n </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Colorectal Disease","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/codi.17274","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

Pelvic floor dysfunction is common and includes symptoms such as urinary incontinence, pelvic pain, faecal incontinence, obstructive defaecation syndrome symptoms and pelvic organ prolapse. It is investigated with defaecation proctography (DP) and integrated total pelvic floor ultrasound (TPFUS). Whilst DP is currently the gold standard, TPFUS is efficient and less invasive, offering additional sphincter function assessment. This study aimed to compare TPFUS accuracy to DP in the evaluation of pelvic floor dysfunction.

Methods

From 2015 to 2016, a prospective observational study was conducted at Guy's and St Thomas's Foundation Trust. Symptomatic women with incomplete evacuation were consecutively invited to participate. Patients underwent three scans using both TPFUS and DP. Reports were independently verified by a blinded consultant. Sensitivity, specificity and agreement were calculated for anatomical (rectocele, intussusception, enterocele, cystocele) and functional (coordination, evacuation) features.

Results

A total of 216 patients were included. Moderate agreement was seen between DP and TPFUS in prediction of rectoceles (positive predictive value 85%, negative predictive value 67%, Cohen's kappa 0.46) and on the evaluation of dimensions of rectoceles (R coefficient 0.55) (P < 0.0001). Fair agreement was seen in the assessment of propulsion (positive predictive value 76%, negative predictive value 50%, Cohen's kappa 0.25). Poor agreement was observed on other anatomical and functional objectives.

Conclusion

This is the most extensive prospective comparison of these imaging modalities. While there is limited correlation between DP and TPFUS in exploring anatomical and functional aspects of pelvic floor disorders, TPFUS proves to be an effective screening tool. With enhanced expertise and confidence in its use, TPFUS could potentially guide surgical planning rather than solely identifying those needing DP.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

我们可以使用综合全盆底超声作为排便性盆底功能障碍的筛查工具吗？综合盆底超声与排便直肠造影准确性的前瞻性评价

目的盆底功能障碍是常见的，包括尿失禁、盆腔疼痛、大便失禁、排便障碍综合征症状和盆腔器官脱垂等症状。采用排便直肠造影（DP）和综合盆底超声（TPFUS）对其进行研究。虽然DP是目前的金标准，但TPFUS效率高，侵入性小，可提供额外的括约肌功能评估。本研究旨在比较TPFUS和DP在评估盆底功能障碍方面的准确性。方法2015 - 2016年，在Guy's and St Thomas's Foundation Trust进行前瞻性观察研究。连续邀请有不完全排空症状的妇女参加。患者接受了三次TPFUS和DP扫描。报告由一位盲人顾问独立核实。计算解剖（直肠膨出、肠套叠、肠膨出、囊膨出）和功能（协调、排泄）特征的敏感性、特异性和一致性。结果共纳入216例患者。DP和TPFUS在预测直肠前突（阳性预测值为85%，阴性预测值为67%，Cohen’s kappa为0.46）和评估直肠前突的尺寸（R系数0.55）（P < 0.0001）方面存在中等程度的一致性。推进力评估结果一致（阳性预测值为76%，阴性预测值为50%，Cohen’s kappa为0.25）。在其他解剖和功能目标上观察到的不一致。结论：这是对这些成像方式最广泛的前瞻性比较。虽然在探索盆底疾病的解剖和功能方面，DP和TPFUS之间的相关性有限，但TPFUS被证明是一种有效的筛查工具。随着对其使用的专业知识和信心的增强，TPFUS可以潜在地指导手术计划，而不是仅仅识别需要DP的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.