Francisco Sérgio Pinheiro Regadas Filho

A novel procedure to assess anismus using three-dimensional dynamic anal ultrasonography.

Objective  This study aimed to determine the value of three‐dimensional (3D) dynamic endosonography in the assessment of anismus.

Ecodefecografia tridimensional dinâmica: nova técnica para avaliação da Síndrome da Defecação Obstruída (SDO)

The aim of the present study is to show novel techniques to evaluate the ODS using dynamic three-dimensional endorectal ultrasound and comparing the results with defecography. Twenty-five adult women were included and distributed in two groups. Group I: Fifteen normal women, mean age 52,4 years old (range 23-76) submitted to full proctologic exam and dynamic 3D anorectal ultrasonography to establish the normal patterns of the rectum and anal canal. Group II: Ten female patients complaining of obstructed defecation, mean age 47,8 years old (33 a 65). The main symptoms were incomplete evacuation, disquezia and vaginal or perineal digitation. They were submitted to full proctologic evaluation, followed by defecography and lastly echodefecography by two examiners without knowing the defecography results. The dynamic echodefecography was performed using B-K Medical® equipment, 360o endoprobe, type 2050, with automatic scan during 50 seconds. The mean angle size formed by the PR at rest position (group I) was 87,13o (range 78,9 - 90,8°) (± 1,01) and 99,22o (range 84,9 - 114,5°) (± 1,84) during evacuatory effort.. It was observed that the angle size increased in all normal women, demonstrating PR relaxation during the evacuatory effort. Concerning to anorectocele evaluation, the posterior vagina wall was kept at horizontal position during the evacuatory effort, except in patients with anorectocele. All patients from group II had anorectocele ( grade I = 1, grade II = 5, grade III = 4) demonstrated at clinical and defecography evaluation. All cases were also confirmed by echodefecography. Based on such results, it was established the reference parameters to classify anorectocele according to echodefecography. (grade I - distance of the vaginal wall positions until 5,0mm, grade II from 6,0 to 12,0mm, grade III above 12,0mm). Defecography identified anismus in one patient with anorectocele grade II and in another with grade III and both were confirmed at echodefecography by decreasing the PR angle when compared the resting with straining positions. Defecography showed also four cases of rectal intussusceptions while echodefecography confirmed such findings and identified two other cases. In conclusion, echodefecography can be used as an alternative method to assess patients with ODS because it identifies and quantifies all the anorectal dysfunctions associated with the obstructed defecation, with the advantage to evaluate also the continence disturbances, identifying sphincter injuries. Its minimally invasive, well tolerated, low cost, no radiation exposure and demonstrates precisely all the anatomic structures involved with defecation.

NEUROMODULAÇÃO SACRAL PARA TRATAMENTO DOS DISTÚRBIOS DO ASSOALHO PÉLVICO. ASPECTOS TÉCNICOS PARA IMPLANTE EFETIVO

intestinal, permaneceu assintomático. Foi a óbito em março de 2017 por causas decorrentes da neoplasia de pâncreas. Discussão: Uma vez implantados, os stents se expandem lentamente, conseguem assim a permeabilidade da anatomia obstruída. Esse método pode ser usado como uma medida paliativa definitiva ou pode ser usado como tratamento provisório ate a estabilização do paciente para posteriormente fazer a cirurgia. É bem estabelecido o uso de stents metálicos em obstrução intestinal, contudo os dados da literatura sobre seu uso por compressões extrínsecas são escassos. Conclusão: Este caso veio corroborar a literatura em relação à boa eficácia e segurança na uso de stents metálicos colorretais nos casos de obstrução intestinal.

Usefulness of anorectal and endovaginal 3D ultrasound in the evaluation of sphincter and pubovisceral muscle defects using a new scoring system in women with fecal incontinence after vaginal delivery

PurposeThis study aims to evaluate pubovisceral muscle and anal sphincter defects in women with previous vaginal delivery and fecal incontinence and to correlate the findings with the severity of symptoms using the combined anorectal and endovaginal 3D ultrasonography with a new ultrasound scoring system.MethodsConsecutive female patients with previous vaginal delivery and fecal incontinence symptoms were screened. Fecal incontinence was assessed with the Cleveland Clinic Florida fecal incontinence scale, and the extent of defects was assessed by an ultrasound score based on results of anorectal and endovaginal 3D ultrasound. Fecal incontinence was assessed with the Cleveland Clinic Florida fecal incontinence scale.ResultsOf 84 women with previous vaginal delivery and fecal incontinence, 21 (25%) had intact pubovisceral muscles and anal sphincters; 63 (75%) had a pubovisceral muscle or anal sphincter defect, or both. Twenty-eight (33%) had a pubovisceral muscle defect [23% with an external anal sphincter (EAS) defect or combined EAS/internal anal sphincter defects; 11% with intact anal sphincters]. Thirty-five (42%) had intact pubovisceral muscles and an anal sphincter defect. Compared with women with intact pubovisceral muscles/anal sphincter defects, patients with pubovisceral muscle defects had significantly higher incontinence scores and significantly higher ultrasound scores indicating more extensive defects. Incontinence symptoms correlated positively with the ultrasound score, measurements of sphincter defects, and area of the levator hiatus.ConclusionsEvaluation of both pubovisceral muscles and anal sphincters is important to identify defects and determine treatment for women with fecal incontinence after vaginal delivery. The severity of fecal incontinence symptoms is significantly related to the extent of defects of the pubovisceral muscles and anal sphincters.