Dynamic anal endosonography may challenge defecography for assessing dynamic anorectal disorders: Results of a prospective pilot study

Background and Study Aims: The diagnosis of anorectal dynamic disorders and perineal insufficiency has been mainly based up to now on the use of defec ography. Here, we performed a prospective blinded study to evaluate the acc uracy of a new procedure, dynamic anorectal endosonography (DAE), by compar ing it with defecography. Patients and Methods: A total of 43 women (mean age 53), presenting with ou tlet obstruction, were prospectively enrolled in our study. The DAE was per formed with a 7.5-Mhz linear probe (Toshiba, Tokyo, Japan) with basal and s training recordings. None of the DAE Or defecography operators was informed about the results of the respective other investigation. Results: Defecography showed a descending perineum in 29 patients (68%), a rectocele in 25 patients (58%), and a rectal intussusception in eight patie nts (18%). The rate of concordance between the diagnosis of descending urin ary bladder at DAE and descending perineum at defecography was 35/43 (80%), and that between the descending puborectal muscle at DAE and descending pe rineum at defecography was 40/43 (93%). The rates of concordance between DA E and defecography for the diagnosis of rectocele and rectal intussusceptio n were 27/43 patients (57%) and 34/43 patients (80%), respectively. In the last 15 patients, the DAE technique was adapted in order to improve the acc uracy for diagnosing rectocele by filling the rectum with,vater. This impro ved sensitivity from 36 to 86% and accuracy from 57 to 87%. Conclusions: DAE is a new imaging approach to anorectal dynamic disorders, providing a highly reliable means of diagnosing perineal insufficiency as w ell as rectocele. DAE should be substituted for previous methods since it m akes it possible at the same time to assess the anal sphincters and to avoi d pelvic irradiation.