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Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence.
Dis Colon Rectum. 2006 May; 49(5):668-78.DC

Abstract

PURPOSE

External anal sphincter atrophy at endoanal magnetic resonance imaging has been associated with poor outcome of anal sphincter repair. We studied the relationship between external anal sphincter atrophy on endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence.

METHODS

In 200 patients (mean Vaizey score, 18 (+/-2.9 standard deviation)) magnetic resonance images were evaluated for external anal sphincter atrophy (none, mild, or severe) by radiologists blinded to anorectal functional test results and details from medical history. Subgroups of patients with and without atrophy were compared for medical history, anal manometry, pudendal nerve latency testing, anal sensitivity testing, external anal sphincter thickness, and external anal sphincter defects. Whenever significant differences were detected, we tested for differences between patients with mild and severe atrophy.

RESULTS

External anal sphincter atrophy was demonstrated in 123 patients (62 percent): graded as mild in 79 (40 percent), and severe in 44 patients (22 percent). Patients with atrophy were more often female (P < 0.001) and older (P = 0.003). They had a lower maximal squeeze (P = 0.01) and squeeze increment pressure (P < 0.001). Patients with severe atrophy had a lower maximal squeeze (P = 0.003) and squeeze increment pressure (P < 0.001) than patients with mild atrophy. These effects were not attenuated by potential confounding variables. Patients with atrophy could not be identified a priori by other characteristics.

CONCLUSIONS

External anal sphincter atrophy at endoanal magnetic resonance imaging was depicted in 62 percent of patients, varying from mild to severe. Because increasing levels of atrophy were associated with impaired squeeze function, further studies are needed to evaluate whether grading atrophy is clinically valuable in selecting patients for anal sphincter repair.

Authors+Show Affiliations

Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.p.terra@amc.uva.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16583292

Citation

Terra, Maaike P., et al. "Relationship Between External Anal Sphincter Atrophy at Endoanal Magnetic Resonance Imaging and Clinical, Functional, and Anatomic Characteristics in Patients With Fecal Incontinence." Diseases of the Colon and Rectum, vol. 49, no. 5, 2006, pp. 668-78.
Terra MP, Deutekom M, Beets-Tan RG, et al. Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Dis Colon Rectum. 2006;49(5):668-78.
Terra, M. P., Deutekom, M., Beets-Tan, R. G., Engel, A. F., Janssen, L. W., Boeckxstaens, G. E., Dobben, A. C., Baeten, C. G., de Priester, J. A., Bossuyt, P. M., & Stoker, J. (2006). Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Diseases of the Colon and Rectum, 49(5), 668-78.
Terra MP, et al. Relationship Between External Anal Sphincter Atrophy at Endoanal Magnetic Resonance Imaging and Clinical, Functional, and Anatomic Characteristics in Patients With Fecal Incontinence. Dis Colon Rectum. 2006;49(5):668-78. PubMed PMID: 16583292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. AU - Terra,Maaike P, AU - Deutekom,Marije, AU - Beets-Tan,Regina G H, AU - Engel,Alexander F, AU - Janssen,Lucas W M, AU - Boeckxstaens,Guy E E, AU - Dobben,Annette C, AU - Baeten,Cor G M I, AU - de Priester,Jacobus A, AU - Bossuyt,Patrick M M, AU - Stoker,Jaap, PY - 2006/4/4/pubmed PY - 2006/6/7/medline PY - 2006/4/4/entrez SP - 668 EP - 78 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 49 IS - 5 N2 - PURPOSE: External anal sphincter atrophy at endoanal magnetic resonance imaging has been associated with poor outcome of anal sphincter repair. We studied the relationship between external anal sphincter atrophy on endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. METHODS: In 200 patients (mean Vaizey score, 18 (+/-2.9 standard deviation)) magnetic resonance images were evaluated for external anal sphincter atrophy (none, mild, or severe) by radiologists blinded to anorectal functional test results and details from medical history. Subgroups of patients with and without atrophy were compared for medical history, anal manometry, pudendal nerve latency testing, anal sensitivity testing, external anal sphincter thickness, and external anal sphincter defects. Whenever significant differences were detected, we tested for differences between patients with mild and severe atrophy. RESULTS: External anal sphincter atrophy was demonstrated in 123 patients (62 percent): graded as mild in 79 (40 percent), and severe in 44 patients (22 percent). Patients with atrophy were more often female (P < 0.001) and older (P = 0.003). They had a lower maximal squeeze (P = 0.01) and squeeze increment pressure (P < 0.001). Patients with severe atrophy had a lower maximal squeeze (P = 0.003) and squeeze increment pressure (P < 0.001) than patients with mild atrophy. These effects were not attenuated by potential confounding variables. Patients with atrophy could not be identified a priori by other characteristics. CONCLUSIONS: External anal sphincter atrophy at endoanal magnetic resonance imaging was depicted in 62 percent of patients, varying from mild to severe. Because increasing levels of atrophy were associated with impaired squeeze function, further studies are needed to evaluate whether grading atrophy is clinically valuable in selecting patients for anal sphincter repair. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/16583292/Relationship_between_external_anal_sphincter_atrophy_at_endoanal_magnetic_resonance_imaging_and_clinical_functional_and_anatomic_characteristics_in_patients_with_fecal_incontinence_ L2 - http://link.springer.com/article/10.1007/s10350-006-0507-4 DB - PRIME DP - Unbound Medicine ER -