Role of three-dimensional ultrasound in females with obstructed defecation (in comparison with defecography)

Abstract

Abstract Background Growing attention of pelvic floor disorders has led to development of new imaging techniques, with increasing importance of ultrasonography. The 3DUS technique is considered an accessible tool for imaging of the posterior pelvic compartment. The purpose of this study is to highlight the role of 3D ultrasound in evaluation of obstructed defecation in females and comparing the findings with defecography. Results Study included 30 females classified into two groups: (1) 20 patients (case group complaining of obstructed defecation); (2) ten females (control group-normal nulliparous females). All of them were subjected to defecography and 3D ultrasound during resting, squeezing, and straining. Detection rate of rectocele and intussusception with 3D ultrasound was lower than defecography. By US, significant statistical difference between patients and controls in all measurements of levator hiatus, IS, ES, and PRS thickness during straining (P value < 0.001). During straining, cut-off value of 20.75 cm2 for hiatal area gives sensitivity of 100% and specificity of 95% and using ARA, cut-off value of 105° gives sensitivity of 98% and specificity of 90% for differentiation between patients and controls. Conclusion Ultrasound can be considered a complementary test to defecography in investigation of patients with obstructed defecation. Ultrasound can diagnose levator muscle attenuation and avulsion, thickness of IS, ES, PRS, and distensibility of hiatal area.

Keywords

• 3D ultrasound
• Obstructed defecation
• Defecography
• Internal sphincter
• External sphincter
• Puborectalis muscle