Barium Defaecating Proctography: Experience from a Tertiary Referral CenterFunding None.
Objective Pelvic floor dysfunction (PFD) is a major health care problem predominately affecting the elderly female. It impairs quality of life and patients increasingly expect a solution. Barium defaecating proctography (BDP) is frequently used in the assessment of patients with PFD. The aim of this study was to present our findings from BDP and to look at the proportion of patients who went on to have surgery following their investigations.
Methods All patients who underwent BDP in a tertiary referral center were identified retrospectively from the computerized radiology information system. Demographic data and radiologic findings were extracted. Data regarding those who had surgery were retrieved from the anonymized patient registry.
Results A total of 671 patients had a BDP during the study period. The main symptoms investigated were obstructed defecation or chronic constipation (64%). Complete barium evacuation was observed in 70% of the patients, while 17% were noted to have incomplete and 13% no evacuation. A large rectocele (>5 cm) was noted in 38% while nearly 5% had frank prolapse. There was no significant association between a rectocele and any of the presenting symptoms. Seventy-eight (12%) patients went on to have operation, of which 17 (22%) had multiple procedures. Three patients ended up with a permanent stoma.
Conclusion BDP contributes to decision making in patients with PFD. However, results need to be interpreted with caution and in conjunction with other tests and clinical examination to maintain a low rate of operation and reduce the risk of adverse outcomes for these patients.
Artikel online veröffentlicht:
23. November 2020
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- 1 Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998; 25 (04) 723-746
- 2 Kenton K, Mueller ER. The global burden of female pelvic floor disorders. BJU Int 2006; 98 (Suppl. 01) 1-5, discussion 6–7
- 3 Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am 2009; 36 (03) 421-443
- 4 Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS. Four-contrast defecography: pelvic “floor-oscopy”.. Dis Colon Rectum 1995; 38 (07) 695-699
- 5 Braekken IH, Majida M, Ellström Engh M, Holme IM, Bø K. Pelvic floor function is independently associated with pelvic organ prolapse. BJOG 2009; 116 (13) 1706-1714
- 6 Data Safe Haven. Available at: https://www.nhsresearchscotland.org.uk/research-in-scotland/data/safe-havens. Accessed October 28, 2019
- 7 Yang XM, Partanen K, Farin P, Soimakallio S. Defecography. Acta Radiol 1995; 36 (05) 460-468
- 8 D’Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 2004; 91 (11) 1500-1505
- 9 Ahmad NZ, Stefan S, Adukia V, Naqvi SAH, Khan J. Laparoscopic ventral mesh rectopexy: functional outcomes after surgery. Surg J (N Y) 2018; 4 (04) e205-e211
- 10 Laparoscopic ventral mesh rectopexy for internal rectal prolapse. Available at: https://www.nice.org.uk/guidance/ipg618. Accessed November 1, 2019
- 11 Vrees MD, Weiss EG. The evaluation of constipation. Clin Colon Rectal Surg 2005; 18 (02) 65-75
- 12 Porter WE, Summitt RL, The Pathophysiology, Diagnosis, and Management of Rectoceles. Global Library of Women’s Medicine. Available at: https://www.glowm.com/section_view/heading/the-pathophysiology-diagnosis-and-management-of-rectoceles/item/58
- 13 Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut 1989; 30 (12) 1737-1749
- 14 Burhenne HJ. Intestinal evacuation study: a new roentgenologic technique. Radiol Clin 1964; 33: 79-84
- 15 Kim NY, Kim DH, Pickhardt PJ, Carchman EH, Wald A, Robbins JB. Defecography: an overview of technique, interpretation and impact on patient care. Gastroenterol Clin North Am 2018; 47 (03) 553-568
- 16 Maglinte DD, Hale DS, Sandrasegaran K. Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: which is the “functional” examination for anorectal and pelvic floor dysfunction?. Abdom Imaging 2013; 38 (05) 952-973
- 17 Pilkington SA, Nugent KP, Brenner J. et al. Barium proctography vs magnetic resonance proctography for pelvic floor disorders: a comparative study. Colorectal Dis 2012; 14 (10) 1224-1230