Clinical relevance of transperineal ultrasound compared with evacuation proctography for the evaluation of patients with obstructed defaecation.

AIM: Dynamic evacuation proctography (DEP) is still considered the gold standard diagnostic procedure for posterior compartment pelvic disorders. The study aimed to assess the value of dynamic transperineal ultrasound (DTPU) compared with DEP in patients with obstructed defaecation syndrome (ODS).
METHOD: In a prospective observational study, 54 consecutive female patients referred with symptoms of ODS between January and June 2009 were studied by clinical evaluation (including Wexner score), perineal ultrasound and defaecography. The tests were analysed by two experienced investigators unaware of the opinion of the other.
RESULTS: DEP revealed a rectocoele in 35 (64%), intussusception in 27 (50%) and enterocoele in 10 (18.5%) patients. DTPU revealed a rectocoele in 32 (59%), intussusception in 23 (42%) and enterocoele in 11 (20%) patients. The degree of agreement of the two techniques calculated using the Cohen kappa method was 0.69 for rectocoele, 0.74 for intussusception and 0.86 for enterocoele. In patients with grade 2-3 rectocoele, the agreement was 0.88. There was no significant difference between the two techniques in the measurement of the anorectal angle or in the detection of dyssynergic contraction of the puborectalis. DTPU was better at identifying multiple diagnoses and associated pelvic floor alterations.
CONCLUSION: The degree of concordance between the two techniques is good. DTPU is accurate for asymptomatic patients with ODS and can be considered an alternative to DEP in the assessment of such patients.