SIMULTANEOUS DYNAMIC PROCTOGRAPHY AND PERITONEOGRAPHY FOR PELVIC FLOOR DISORDERS

PURPOSE: We sought to evaluate a new diagnostic technique for the iden tification of rectal and pelvic floor pathology in patients with obstr ucted defecation, pelvic fullness/ prolapse, and/or chronic intermitte nt pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctogr aphy (DPG) were studied. After placement of intraperitoneal and intrar ectal contrast material, resting and straining pelvic x-rays were obta ined in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically s uspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the techn ique in three of the women studied. Rectoceles and rectal prolapse tha t were identified during physical examination were confirmed by DPG wi th peritoneography. Simultaneous DPG and peritoneogphy also gave a qua litative assessment of the severity and clinical significance of the i dentified pelvic floor disorders. Results of simultaneous DPG and peri toneography affected operative treatment planning in 85 percent of pat ients studied. CONCLUSION: Simultaneous DPG and peritoneography identi fies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for bette r treatment planning in selected patients with obstructed defecation a nd pelvic prolapse.