External anal sphincter volume measurements using 3-dimensional endoanal ultrasound (original) (raw)
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Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2016
Endoanal ultrasound (EAUS) is the gold standard investigation of anal sphincter integrity. Aim of this study was to compare the sensitivity and specificity of 3D-EAUS with 2D and 3D transperineal US (TPUS), and 3D endovaginal US (EVUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). The external (EAS) and internal anal sphincters (IAS) were evaluated in women with OASIS by four ultrasound modalities. 2D-TPUS was evaluated real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated off-line by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded, and defects were scored according to the Starck's system. Sensitivity, specificity, and predictive values were calculated, using 3D-EAUS as reference standard. Interobserver and intraobserver analysis were obtained. Association between patients' symptoms (Wexner's score) and US findings (Starck's score) was also calculated. Images from 55 ...
Shape and volume of internal anal sphincter showed by three-dimensional anorectal ultrasonography
European Journal of Radiology, 2012
The aim of this work is to characterize the shape and the volume of the internal anal sphincter (IAS) in normal subjects by three-dimensional anorectal ultrasonography. Methods: Thirty-nine normal volunteer males (mean age 58.5 ± 18.7) and 25 females (mean age 59.4 ± 14.1) were submitted to anorectal ultrasonography. The tissue is defined by a semiautomatic procedure. Measurements of thickness, length and volume were assessed automatically. The software provides an average number of 57,600 thickness measurements, 360 length measurements for each zone (90 for each quadrant) and seven volume measurements (one for each anatomical area).The mean values of magnitudes were calculated for the entire volume in each quadrant and zone. Age and gender-related variations were analyzed. Results: In assessments of the whole tissue, only thickness was gender-related, with greater thickness for females (male thickness: 1.81 ± 0.47 mm, female thickness 2.16 ± 0.57 mm, P-value < 0.01).In the distal zone: thickness, length and volume were all larger in females (for male and female respectively: 1.83 ± 0.49 mm vs 2.34 ± 0.58 mm, P-value < 0.01, for the thickness; 10.87 ± 2.10 mm vs 12.18 ± 2.21 mm, P-value < 0.02 for the length and 1501 ± 605 mm 3 vs 2169 ± 871 mm 3 , P-value < 0.01 for the volume). In the medial zone, only thickness was gender-related, with greater thickness in females (male thickness: 2.04 ± 0.60 mm, female thickness:2.44 ± 0.74 mm, P-value < 0.02).The only variation observed in the proximal zone concerned length, larger in males (respectively: 11.27 ± 2.84 mm vs 9.55 ± 2.43 mm, P-value < 0.02). The male population was significantly positively correlated with ageing for volume in the whole tissue (= 0.32, P-value < 0.05), and for both thickness and volume in the medial zone (= 0.33, P-value < 0.05 for thickness; = 0.39, P-value < 0.02 for the volume). Conclusion: This new method is useful to understand both functional anal disorders and local damage which may affect only part of the muscle tissue.
Journal of Ultrasound in Medicine, 2019
ObjectivesExoanal 4‐dimensional translabial ultrasound (TLUS) is increasingly used to image the anal sphincter. The aim of this study was to define the limits of normality for assessment of external and internal anal sphincters with TLUS.MethodsThis study was a retrospective analysis using data sets of nulliparous women seen antenatally. All women had a 4‐dimensional TLUS examination at a mean gestational age ± SD of 36 ± 0.7 (range, 32.9–37.3) weeks. Anal sphincter biometry, including external anal sphincter (EAS) length and thickness, EAS proximal rotational asymmetry, and internal anal sphincter thickness, was assessed blinded against other data.ResultsA test‐retest series showed good repeatability (intraclass correlation coefficients, 0.619–0.849) of all parameters. The mean age of the women (n = 111) was 30.9 (range, 18.8–40.5) years. None reported anal incontinence. On tomographic imaging, none showed anal sphincter defects. The mean EAS length was 17.5 (range, 8.4–34.8) mm, b...
Journal of Ultrasound
Introduction Endoanal ultrasound (3D-EAUS) is the gold standard imaging investigation for evaluating the anal sphincter; unfortunately, it is not universally available in most obstetric units. This study aims to appraise the ability of transperineal ultrasound (TPUS) compared with 3D-EAUS as the gold standard to identify anal sphincter defects after primary repair of OASIS. Methods A systematic search of major databases to identify diagnostic accuracy of 3D-TPUS in evaluating anal sphincter defects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were designed for this systematic review. The risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Our eligibility criteria are patients with a history of primary repair of anal sphincter injuries (OASIS). They were followed up after the primary repair to detect the anal sphincter defect using 3D-TPUS vs. 3D-EAUS as a gold standard. Results Two eligible observational studies w...
Ultrasound in Obstetrics and Gynecology, 2007
Objective Intrapartum damage to the anal sphincter is an important factor in fecal incontinence. Recognized lacerations occur in 0.36-8.4% of vaginal deliveries, and occult sphincter damage in up to 35% of primiparous women. We examined the role of three-dimensional transperineal ultrasound (3DTUS) in the evaluation of the anal sphincter in primiparous women after vaginal delivery and after surgical repair of third-degree intrapartum tears by the overlapping technique. Methods During 2004-2005 139 primiparous women without clinically recognized third-to fourth-degree anal sphincter tears were prospectively studied 24-72 h postpartum (Group 1) and 13 primiparous women were examined 48 h to 4 months following surgical repair of third-degree tears with the overlapping technique (Group 2). A 3D 5-9-MHz transvaginal probe was placed in the area of the fourchette and perineal body in transverse and sagittal planes and 2-4 volumes were stored. The parameters studied were: examination duration; continuity of the internal and external sphincters; occult sphincter damage; internal sphincter and external sphincter width-measured 1.5 cm from the distal margin of the anus-at the '12, 3, 6 and 9 o'clock positions'; length of the posterior internal sphincter. Results Scanning was possible in all women and the stored volumes were adequate in 127/139 (91.4%) cases. Mean examination time was 3.5 min. In Group 1, occult sphincter defect was suspected in 10/127 women (7.9%). These patients were excluded from measurement calculations, leaving 117 cases for analysis. The internal sphincter was consistently visualized in all the remaining patients (n = 117), while the external sphincter was fully visualized in 99/117 women (84.6%), and partially visualized in the remainder. Mean internal sphincter thickness was 2.60, 2.55, 2.60 and 2.72 mm at the 12, 3, 6 and 9 o'clock positions, respectively, and mean internal sphincter length was 3.34 cm. Mean external sphincter thickness was 4.15, 4.20, 4.21 and 4.20 mm at the 12, 3, 6 and 9 o'clock measurement points. In Group 2, 3DTUS confirmed anatomic abnormalities in all the women in the area surrounding the 12 o'clock position. Evaluation of sphincter tears and their position and length was possible using the longitudinal view. Thinning of the internal sphincter in the area of damage and thickening on the opposite side, the 'half moon sign', sphincter discontinuity, thickening of the external sphincter in the area of repair and abnormality of mucous folds, seemed to be common signs of third-degree intrapartum sphincter tears, even after repair. Conclusions 3DTUS is an accessible and promising method for postpartum sphincter evaluation, that is apparently well tolerated by patients. Reference data for sphincter anatomy representative of findings at transperineal ultrasound in primiparous women in the postpartum period have been established.
International Urogynecology Journal, 2020
Introduction and hypothesis Our aim was to explore the association between anal incontinence (AI) and persistent anal sphincter defects diagnosed with 3D endoanal (EAUS), introital (IUS) and transperineal ultrasound (TPUS) in women after obstetric anal sphincter injury (OASI) and study the association between sphincter defects and anal pressure. Methods We carried out a cross-sectional study of 250 women with OASI recruited during the period 2013–2015. They were examined 6–12 weeks postpartum or in a subsequent pregnancy with 3D EAUS, IUS and TPUS and measurement of anal pressure. Prevalence of urgency/solid/liquid AI or flatal AI and anal pressure were compared in women with a defect and those with an intact sphincter (diagnosed off-line) using Chi-squared and Mann–Whitney U test. Results At a mean of 23.6 (SD 30.1) months after OASI, more women with defect than those with intact sphincters on EAUS had AI; urgency/solid/liquid AI vs external defect: 36% vs 13% and flatal AI vs inte...
Journal of Coloproctology, 2017
Purpose Anal sphincter injury after delivery is the main factor in the pathogenesis of fecal incontinence. Clinical obvious and specific injury to anal canal sphincter is seen in 3% of vaginal deliveries. There are many women who do not have a clear and specific laceration but they are damaged by sphincter muscles of anal canal. The purpose of the present study is to investigate the frequency of occult anal sphincter injury after vaginal delivery by Endo-anal sonography. Methods Fifty women with first pregnancy were assessed at 27–33 weeks of pregnancy, and at 6 weeks and 6 months after vaginal delivery by questionnaire, examination and Endo-anal sonography. Women age, duration of delivery, the effect of epidural anesthesia, episiotomy and birth weight were studied and Endo-anal sonography results were recorded. Anal manometry was performed for all mothers before delivery and 5 ones with sphincter injury at 6 months and 3 years after delivery. Results Five (10%) patients, with mean ...