Dynamic transperineal ultrasound in the workup of men with obstructed defecation: a pilot study

BACKGROUND: Dynamic transperineal ultrasound has been used in women for the\r\nnoninvasive investigation of functional disorders of the posterior pelvic floor, \r\nbut its use in men has been limited by technical difficulties related to the\r\nconsistency of the male perineum.\r\nOBJECTIVES: The aim of this study was to explore the efficacy of dynamic\r\ntransperineal ultrasound in diagnosing posterior pelvic floor dysfunction in men.\r\nDESIGN: This is a study of diagnostic accuracy.\r\nSETTINGS: This study was performed at a public hospital.\r\nPATIENTS: Forty-six men with symptoms of obstructed defecation were included.\r\nINTERVENTIONS: All patients underwent dynamic transperineal ultrasound 1 week\r\nafter standard defecography with manometric confirmation when rectoanal\r\ndyssynergy was observed.\r\nMAIN OUTCOME MEASURES: Images were obtained, and anorectal angles were measured\r\nunder resting conditions and during maximal strain. The accuracy of the\r\nsonographic method in diagnosing pelvic floor alterations was assessed against\r\ndefecography (reference method).\r\nRESULTS: : Anorectal angles measured with ultrasound and defecography were not\r\nsignificantly different under resting conditions or maximum strain. Sonographic\r\nand reference method findings were concordant in 41 (89.1%) of the cases (25 with\r\nrectoanal intussusceptions, 7 with rectorectal intussusceptions, 8 with rectoanal\r\ndyssynergy, and 1 with rectorectal intussusception and dyssynergy). In 1 patient \r\nwith rectoanal intussusception, dynamic transperineal ultrasound was\r\nnondiagnostic (low image quality probably due to dehydration of perineal\r\ntissues). Discordant dynamic transperineal ultrasound findings included normal\r\nfindings in another patient with rectoanal intussusception, diagnosis of\r\nrectoanal intussusception in 2 men with rectorectal intussusception, and failure \r\nto detect dyssynergy in a second patient with rectorectal intussusception and\r\ndyssynergy. The sensitivity, specificity, and Cohen κ indices for dynamic\r\ntransperineal ultrasound were 92.6%, 90.5%, and 82% (rectoanal intussusception); \r\n81.8%, 100%, and 87% (rectorectal intussusception); 90%, 100%, and 93% (rectoanal\r\ndyssynergy).\r\nLIMITATIONS: This study was limited by its small size and by the absence of\r\npatients with other morphofunctional disorders associated with obstructed\r\ndefecation.\r\nCONCLUSIONS: Dynamic transperineal ultrasound is potentially useful for diagnosis\r\nand follow-up of posterior pelvic floor dysfunction in men.