PATIENT POSITION DURING CINEDEFECOGRAPHY - INFLUENCE ON PERINEAL DESCENT AND OTHER MEASUREMENTS

PURPOSE: This study was undertaken to assess the reproducibility of ci nedefecography measurements and abnormal findings between the left lat eral decubitus and seated positions. METHODS: Prospective patient eval uation included all patients who had lateral radiographs of the pelvis taken at rest, during squeezing, and pushing in both positions. Anore ctal angle, perineal descent, and puborectalis length measurements wer e calculated for each set of radiographs. Pelvic floor dynamics during evacuation were measured as the changes between rest and pushing. Abn ormal findings included both increased dynamic and fixed perineal desc ent, nonrelaxing puborectalis, and premature evacuation. RESULTS: One hundred five consecutive patients underwent cinedefecography. There we re statistically significant differences between the positions with re gard to anorectal angle (P < 0.0001), perineal descent (P = 0.0001), a nd puborectalis length (P = 0.0001). Dynamic changes of the anorectal angle, perineal descent, and puborectalis length were not significantl y different (P > 0.05). However, 6 of 22 (27 percent) patients with fe cal incontinence had premature evacuation severe enough to impede meas urement only when seated (P = 0.05). CONCLUSION: Because of the statis tically significant differences between the two positions, centers sho uld always employ the same position for a given diagnostic group.