Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity?

Lisa Ramage,Paul Mclean,Shengyang Qiu,Christos Kontnvounisios,Panagiotis Georgiou,Emile Tan,Nasir Khan,Paris Tekkis

doi:10.1007/s13304-017-0506-0

Abstract

MR defecography (MRD) is an alternative to conventional defecography (CD) which allows for dynamic visualisation of the pelvic floor. The aim of this study was to assess whether MRI features indicative of pelvic floor dysfunction correlated with patient-reported symptom severity. MR proctograms were matched to a prospectively-maintained functional database. Univariate and multivariate analyses were performed using pre-treatment questionnaire responses to the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score (WIS), and modified Obstructed Defecation Symptom (ODS) Score. 302 MRI proctograms were performed between January 2012 and April 2015. 170 patients were included. Patients with a rectocele > 2 cm (p = 0.003; OR 5.756) or MRD features suggestive of puborectalis syndrome (p = 0.025; OR 8.602) were more likely to report a higher ODS score on multivariate analysis. Lack of rectal evacuation was negatively associated with an abnormal WIS (p = 0.007; OR 0.228). Age > 50 (p = 0.027, OR 2.204) and a history of pelvic floor surgery (p = 0.042, OR 0.359) were correlated with an abnormal BBUSQ incontinence score. Lack of rectal evacuation (p = 0.027, OR 3.602) was associated with an abnormal BBUSQ constipation score. Age > 50 (p = 0.07, OR 0.156) and the presence of rectoanal intussusception (p = 0.010, OR 0.138) were associated with an abnormal BBUSQ evacuation score. Whilst MRD is a useful tool in aiding multidisciplinary decision making, overall, it is poorly correlated with patient-reported symptom severity, and treatment decisions should not rest solely on results.

Highlights

Magnetic-resonance defecography (MRD) was first introduced in 1993 [1] as a means of dynamic multi-compartmental visualisation of the pelvic floor
Whilst MRD is a useful tool in aiding multidisciplinary decision making, overall, it is poorly correlated with patient-reported symptom severity, and treatment decisions should not rest solely on results
The present study aimed to assess whether features suggestive of pelvic floor dysfunction as seen on MR defecography had any correlation with patient-reported severity of symptoms

Summary

Introduction

Magnetic-resonance defecography (MRD) was first introduced in 1993 [1] as a means of dynamic multi-compartmental visualisation of the pelvic floor. Its main advantages over fluoroscopic techniques, such as conventional defecography (CD), were the depiction of significantly higher anatomical detail of the pelvis achievable through T2-weighted images, and the ability to assess the movements of the anterior, middle, and posterior compartments of pelvis and its surrounding structures dynamically. MRD has been shown to be useful in the diagnosis of pelvic floor dysfunction, in the differential diagnosis of pelvic organ prolapse, evacuatory as well as continence disorders. It has utility in assessing the surrounding organs, in particular the uterus and vagina in women, and the

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