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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Ann+Coloproctol
2016 ; 32
(5
): 170-174
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English Wikipedia
Anismus, Physiology, Radiology: Is It Time for Some Pragmatism? A Comparative
Study of Radiological and Anorectal Physiology Findings in Patients With Anismus
#MMPMID27847787
Pisano U
; Irvine L
; Szczachor J
; Jawad A
; MacLeod A
; Lim M
Ann Coloproctol
2016[Oct]; 32
(5
): 170-174
PMID27847787
show ga
PURPOSE: Anismus is a functional disorder featuring obstructive symptoms and
paradoxical contractions of the pelvic floor. This study aims to establish
diagnosis agreement between physiology and radiology, associate anismus with
morphological outlet obstruction, and explore the role of sphincteric pressure
and rectal volumes in the radiological diagnosis of anismus. METHODS: Consecutive
patients were evaluated by using magnetic resonance imaging
proctography/fluoroscopic defecography and anorectal physiology. Morphological
radiological features were associated with physiology tests. A categorical
analysis was performed using the chi-square test, and agreement was assessed via
the kappa coefficient. A Mann-Whitney test was used to assess rectal volumes and
sphincterial pressure distributions between groups of patients. A P-value of
<0.05 was significant. RESULTS: Forty-three patients (42 female patients)
underwent anorectal physiology and radiology imaging. The median age was 54 years
(interquartile range, 41.5-60 years). Anismus was seen radiologically and
physiologically in 18 (41.8%) and 12 patients (27.9%), respectively. The
agreement between modalities was 0.298 (P = 0.04). Using physiology as a
reference, radiology had positive and negative predictive values of 44% and 84%,
respectively. Rectoceles, cystoceles, enteroceles and pathological pelvic floor
descent were not physiologically predictive of animus (P > 0.05). The
sphincterial straining pressure was 71 mmHg in the anismus group versus 12 mmHg.
Radiology was likely to identify anismus when the straining pressure exceeded 50%
of the resting pressure (P = 0.08). CONCLUSION: Radiological techniques detect
pelvic morphological abnormalities, but lead to overdiagnoses of anismus. No
proctographic pathological feature predicts anismus reliably. A stronger pelvic
floor paradoxical contraction is associated with a greater likelihood of
detection by proctography.