EP805 - A novel 3D linear dynamic anorectal ultrasonography technique for pelvic floor dysfunctions assessment. How effective is the technique?

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Purpose/Background: Advances in technologies make possible the development of a new transducer for pelvic floor dysfunctions assessment. New devices are available with high resolution images, increasing new options alternative for pelvic dysfunctions diagnosis .Moreover, each new diagnostic option has opened opportunity to standardize new techniques to be successfully used in pelvic floor centers. This study describes a novel 3D linear dynamic anorectal ultrasound technique (linear 3D) for pelvic floor dysfunctions assessment, as well as standardized comparing with Echodefecography(3D anorectal dynamic technique – EDF)

Methods/Interventions: A prospective study was accomplished with 32 women, mean age 56, with pelvic floor dysfunctions from March to September 2024. All of them were assessed by symptoms and scores as well as underwent to Echodefecography and dynamic linear 3D techniques. Both transducers are endocavity, with automatic scanning and built-in high resolution 3D, enabling easy review of 3D datasets. However, in the EDF, the longitudinal 360°acquisition move with sector angle from proximal to distal by 6cm, and in the linear 3D acquisition, image is built-in linear array with 360° rotation for 6cm. The diagnostic accuracy of the linear 3-D was evaluated using the EDF as the standard for comparison and performed by different examiners. Both techniques were performed by anorectal approach to assess the sphincter muscles, as well as to evaluate the dynamic dysfunctions by the sequence of resting, pushing and at rest. Those with previous vaginal delivery, an additional transvaginal approach were included to assess the levator ani muscles. In the 3D linear technique, the crystal moves starting from nine and from three o'clock positions, following the sequence of five seconds at rest, 20s pushing and 35s at rest to assess the hole circumference. The data were analyzed using Student’s t test and were calculated based on sensitivity, specificity, positive and negative predictive values.

Results/Outcomes: Of 32 women, 15 had at least one vaginal delivery; 28 complains of obstructed defecation (mean 11 Renzi score); 12 of fecal incontinence(mean 7.5 CCF score) and 5 of urinary incontinence. Nineteen(59%) had at least anal sphincter or/and levator ani muscles defect. The 3D linear showed high sensitivity, specificity, positive and negative predictive values in the diagnosis of dysfunctions(Table). The anorectal angle failed to open during straining in 25 patients on EDF(mean difference: -8.3°±5.4) and in 23 on linear 3D(-7.8°±8.2). The increase during straining was in 7 on EDF(mean difference:+8.4°±5.2) and in 9 on linear 3D(+5.2°±2.9). The mean difference in angle was similar for both techniques. There were a correlation regarding rectocele depth: 8 patients had grade III rectocele(depth>1.3cm in both; except one patient grade I: 0.6cm by 3D linear), two had grade II rectocele(depth 0.8-1.2cm in both), and 3 had grade I rectocele depth( < 0.8cm in both) by EDF and two cases by linear 3D. All cases of cystocele(11) were identified in both techniques as well as the displacement of bladder was similar.

Conclusion/Discussion: This new Linear 3D technique correlates with EDF since that using similar approach as well as the landmark to measure the angles and rectocele depth, becoming a new method to assess the sphincter and levator ani muscles as well as the dynamic dysfunctions of pelvic floor with a linear transducer and have only one type transducer to full diagnostic. However, the new technique should be validated in multiples centers.