Evaluate the applicability of a novel technique using dynamic tridimensional
transvaginal / transrectal ultrasound as an alternative diagnostic method to evaluate the
obstructed defecation, comparing with Echodefecography. It is a prospective and
comparative exam, involving female patients with obstructed defecation, mean Wexner
constipation score higher than 6. All patients were submitted to dynamic tridimensional
ultrasound by two different techniques to identify all the obstructed defecation
dysfunctions. The Echodefecography was used as the standard method to evaluate the
dynamic tridimensional transvaginal / transrectal ultrasound technique. After
introducing 120 mL gel into the rectum, it was used the transvaginal approach to
evaluate the anorectal angle at rest and during evacuatory effort to identify the
Puborectal muscle relaxation or paradoxical contraction (Anismus). Using the
transrectal approach, it was evaluated the presence of different sizes of Rectocele,
Intussusception and Enterocele / Sigmoidocele during evacuatory effort. All data were
compared. It was used Student t Test and Lee Kappa Correlation Coefficient for
statistical analysis. It was calculated efficacy, sensibility, specificity, positive predictive
valour, negative predictive valour of the combined transvaginal / transrectal ultrasound
technique to identify each dysfunction. Thirty three female patients, mean age 48 years
old, mean Wexner constipation score 10 (range 7 - 14) were included. There was
substantial concordance between both exams to identify Anismus and normal relaxation
(K=0.683). There was significant reduction in the anorectal angle in 19 patients
submitted to Echodefecography (84.79 Â Â 1.008 x 80.11Â Â 1.725), with mean change
of 5Â ( Â4,738 ) and in 17 patients evaluated by the transvaginal / transrectal Ultrasound
(120.5Â Â 2.378 x 109.6Â Â 3.449), with mean change of 10,82ÂÂ8,164. The difference
between the angles was significantly higher in patients evaluated by transvaginal /
transrectal Ultrasound when compared with Echodefecography (15.45Â Â 1.539 x 7.182Â
 0.9804) (p=0,0001). It was identified Rectocele in 27 patients and absent in 6 in both
techniques used, demonstrating almost perfect concordance index (K=1.0). It was
demonstrated 12 patients with grade III Rectocele, 9 with grade II and 3 with grade I in
both techniques used, demonstrating almost perfect concordance index for different
grades of Rectocele (K= 0.812) (K=0.857) (K= 0.841). There was disagreement in only
3 patients between both methods, 2 with grade III in Echodefecography and grade I and
II in transvaginal / transrectal Ultrasound. Another one with grade II in
Echodefecography and grade III in transvaginal / transrectal Ultrasound. Comparing
both methods, there was no statistically significant difference with respect to the degree
of Rectocele (1,076Â0,6838 x 1,139Â0,7267) (p=0,7153). There was almost perfect
concordance index in identification of rectal Intussusception (K= 0.914) and Enterocele
/ Sigmoidocele (K= 0.659). It was demonstrated valor higher than 87,6% of efficacy,
sensibility, specificity, positive predictive valor, negative predictive for each evaluated
dysfunction. In conclusion, the technique using dynamic tridimensional transvaginal /
transrectal Ultrasound showed high concordance index with Echodefecography and can
be used as an alternative method to evaluate patients with obstructed defecation
symptoms. / O estudo busca verificar a aplicabilidade de uma nova tÃcnica utilizando o Ultrassom
trans-vaginal / trans-retal tridimensional dinÃmica como um mÃtodo diagnÃstico
alternativo na avaliaÃÃo da evacuaÃÃo obstruÃda, comparando com a Ecodefecografia.
Trata-se de um estudo prospectivo e comparativo, envolvendo pacientes do sexto feminino,
com evacuaÃÃo obstruÃda e escore mÃdio de constipaÃÃo de Wexner acima de 6. Todas as
pacientes foram submetidas ao exame ultrassonogrÃfico tridimensional dinÃmico por duas
tÃcnicas distintas para identificar as disfunÃÃes responsÃveis pela defecaÃÃo obstruÃda. A
Ecodefecografia foi utilizada como mÃtodo padrÃo na avaliaÃÃo comparativa da tÃcnica de
Ultrassom combinado transvaginal/transretal tridimensional dinÃmica. ApÃs a introduÃÃo
de 120 mL de gel na ampola retal, utilizou-se o acesso transvaginal para avaliar o Ãngulo
anorretal em repouso e durante o esforÃo evacuatÃrio para identificar o relaxamento ou
contraÃÃo paradoxal do mÃsculo Puborretal (Anismus). Utilizando o acesso transretal
avaliou-se a presenÃa de Retocele nos diferentes tamanhos, IntussuscepÃÃo e Enterocele /
Sigmoidocele durante o esforÃo evacuatÃrio. Os achados foram comparados entre si. A
anÃlise estatÃstica foi realizada utilizando o test t de Student e o Coeficiente de correlaÃÃo
Lee Kappa. Calculou-se a eficÃcia, sensibilidade, especificidade, valor preditivo positivo,
valor preditivo negativo da tÃcnica do Ultrassom combinado transvaginal e transretal para
identificaÃÃo de cada disfunÃÃo. Foram incluÃdas 33 pacientes do sexo feminino, idade
mÃdia 48 anos, escore mÃdio de constipaÃÃo de Wexner de 10 (7 - 14). Houve substancial
concordÃncia entre os dois exames para identificaÃÃo de Anismus e relaxamento normal
(K=0.683). Houve reduÃÃo significante do Ãngulo anorretal em 19 pacientes submetidas a
Ecodefecografia (84.79 Â Â 1.008 x 80.11Â Â 1.725), com variaÃÃo mÃdia de 5Â ( Â4,738 )
e em 17 pacientes avaliadas pelo Ultrassom transvaginal / transretal (120.5Â Â 2.378 x
109.6Â Â 3.449), com variaÃÃo mÃdia de 10,82ÂÂ8,164. A diferenÃa entre os Ãngulos foi
significantemente maior nas pacientes avaliadas pelo Ultrassom transvaginal / transretal
quando comparada com a Ecodefecografia (15.45Â Â 1.539 x 7.182Â Â 0.9804) (p=0,0001).
Foi identificada Retocele em 27 pacientes e ausÃncia em 6 em ambas as tÃcnicas utilizadas,
demonstrando Ãndice de concordÃncia quase perfeito (K=1.0). Doze pacientes
apresentaram Retocele grau III, 9 grau II e 3 grau I em ambas as tÃcnicas utilizadas,
demonstrando um Ãndice de concordÃncia quase perfeito para os diferentes graus da
Retocele (K= 0.812) (K=0.857) (K= 0.841). Somente 3 pacientes foram discordantes entre
os dois mÃtodos, sendo duas com grau III na Ecodefecografia e grau I e II no ultrassom
transvaginal / transretal. Uma outra com grau II na Ecodefecografia e grau III no
Ultrassom transvaginal / transretal. Comparando os dois mÃtodos, nÃo houve diferenÃa
estatisticamente significante com relaÃÃo ao grau da Retocele (1,076Â0,6838 x
1,139Â0,7267) (p=0,7153). Houve um Ãndice de concordÃncia quase perfeito na
identificaÃÃo de IntussucepÃÃo retal (K= 0.914) e Enterocele/Sigmoidocele (K= 0.659).
Foram demonstrados valores acima de 87,5% de eficÃcia, sensibilidade, especificidade,
valor preditivo positivo, valor preditivo negativo para cada disfunÃÃo avaliada. Conclui-se
que a tÃcnica utilizando Ultrassom transretal / transvaginal tridimensional dinÃmica
apresenta elevado Ãndice de concordÃncia com a Ecodefecografia, podendo ser utilizada
como mÃtodo alternativo para avaliaÃÃo de pacientes portadoras de sintomas de evacuaÃÃo
obstruÃda.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:8011 |
| Date | 22 March 2013 |
| Creators | Francisco SÃrgio Pinheiro Regadas Filho |
| Contributors | Sthela Maria Murad Regadas, Lusmar Veras Rodrigues, Jose Vinicius Cruz |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Cirurgia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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