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 2.9 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

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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.

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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.