The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients
The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients
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DOI：
10.1007/s00192-015-2914-3
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发表时间：
2016-06-01
影响因子：
1.8
通讯作者：
Dietz, Hans Peter
中科院分区：
文献类型：
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作者：
Rojas, Rodrigo Guzman;Atan, Ixora Kamisan;Dietz, Hans Peter
梗阻性排便(OD)的前言和假说症状在女性中很常见。经会阴超声(TPUS)已被用于评估排便障碍。我们研究的目的是确定在三级泌尿外科诊所就诊的女性中后室解剖异常的总体发生率及其与OD的相关性。方法对750名在三级泌尿外科就诊的女性进行了回顾性研究，她们接受了标准化的访谈、临床检查和4D经颅多普勒超声检查。采用单因素和多因素Logistic回归分析研究检查结果与OD症状之间的关系。这项研究得到了当地人类研究伦理委员会(Nepean Blue Mountain地方卫生区人类研究伦理委员会，IRB批准编号13-16)的批准。平均年龄56.1(18.4~87.6)岁。大便失禁97例(13%)，便秘190例(26%)，OD症状461例(%)。在检查中，405名妇女(56%)被诊断为明显的后室脱垂(POP-Q>；=2期)，这与OD的症状有关(P<；0.0001)。超声检查，103例(14%)为肠膨出，382例(53%)为真直肠前突，31例(4.3%)为直肠套叠。经多因素分析，真性直肠前突(p=0.003)和直肠套叠(p=0.004)仍与OD症状显著相关。结论OD症状和后室解剖异常在妇科患者中均较常见。真正的直肠前突和直肠套叠的超声表现与排便梗阻显著相关。
Introduction and hypothesis Symptoms of obstructive defecation (OD) are common in women. Transperineal ultrasound (TPUS) has been used for the evaluation of defecatory disorders. The aim of our study was to determine the overall prevalence of anatomical abnormalities of the posterior compartment and their correlations with OD in women seen in a tertiary urogynecology clinic.Methods This is a retrospective study on 750 women seen at a tertiary urogynecological unit who had undergone a standardized interview, clinical examination, and 4D TPUS. Univariate and multivariate logistic regression analyses were undertaken to study the association between examination findings and symptoms of OD. This study was approved by the local human research ethics committee (Nepean Blue Mountains Local Health District Human Research Ethics Committee, IRB approval no. 13-16).Results The datasets of 719 women were analyzed. Mean age was 56.1 (18.4-87.6) years. Ninety-seven patients (13 %) reported fecal incontinence, 190 (26 %) constipation, and 461 (64 %) symptoms of OD. On examination, 405 women (56 %) were diagnosed with significant posterior compartment prolapse (POP-Q >= stage 2), which was associated with symptoms of OD (p < 0.0001). On ultrasound, 103 (14 %) patients had an enterocele, 382 (53 %) a true rectocele and 31 (4.3 %) had rectal intussusception. On multivariate analysis true rectocele (p = 0.003) and rectal intussusception (p = 0.004) remained significantly associated with symptoms of OD.Conclusion Both symptoms of OD and anatomical abnormalities of the posterior compartment are highly prevalent in urogynecological patients. Ultrasound findings of a true rectocele and rectal intussusception are significantly associated with obstructed defecation.