May 2014
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16 Reads
Objective Objective Methods Methods Conclusions Conclusions • The diagnostic options for outlet obstruction and obstructive defecation syndrome(s) are limited on MR-defecography as the current gold standard examination, proctological examination and anamnesis with using of standarized questionnaire (scores) to evaluate the symptoms. A difficult determination of often manifold and varying symptoms many times corresponds to the often non-satisfing results of the applied therapy. Our hypothesis was, that this is due to the indirect unphysiological (supine position) examination method and frequently imprecise and patient-side misunderstood surveys. This leads to interventions, which do not have the chance to be successful or treatments which could not be followed by patients (physiotherapy used for patients which can not perform pelvic muscle contractions). • Therefore the current diagnostic methods should be replaced by objective examinations performed in the more physiological sitting position. This option is given by dynamic three dimensional EUS, which can reliably detect all pathological changes of the pelvic floor. Additionally it is a cost-efficient method and easy to perform. With this technique all three pelvic floor compartments can be seen in real-time and individual therapy concepts for each patient can be developed • 480 female patients with ODS-Syndrome have been examinated by using dynamic 3D ultrasound scanner Focus ® Pro with the transducers 2052, 8802 and 8848 (BK Medical). The aim was to compare the findings of pelvic floor disorders regarding to the examination position (supine vs. sitting). • we found in 480 examinated patients a rectocele 146 (supine 39,4%) vs. 370 (sitting 100%), cystocele 59 (supine, 21,4%) vs. 275 (sitting, 100%), enterocele 1 (supine, 6,25 %) vs. 16 (sitting, 100%), perineal descensus 166 (supine, 38,8%) vs. 427 (sitting, 100%), intussusception 1 (supine, 33,3 %) vs. 3 (sitting, 100%) and anismus 0 (supine, 0%) vs. 15 (sitting, 100%). The patient position during the examination seems to be crucial for detecting pelvic floor disorders. The dynamic 3D EUS on pelvic floor offers a solid, easy to perform, cost-effective and most importantly (due to physiological examination position), a meaningful method to evaluate all pelvic floor disorders. Subsequently it allows to select an individual therapy concept or surgical procedure for each patient. This could offer an improvement of the outcome of conservative and surgical treatment options. The results of MR Defecography (untill now gold standard examination) should be reevaluated regarding our findings because of the not physiological supine position during the examination.