Title: OC261: Comparison of defecography and 3D/4D translabial ultrasound in patients with pelvic organ prolapse and/or evacuation disorders
Abstract: Defecography is still considered to be the gold standard for objective diagnosis of pelvic organ prolapse, but is relatively invasive and costly. This study was designed to assess the level of agreement between defecography and non-invasive 3D/4D transperineal ultrasound for detection of central and posterior compartment prolapse abnormalities in patients complaining of pelvic floor prolapse symptoms and/or evacuation disorders. Seventy-two patients were included in a prospective observational study. The colpodefecography (CCD) was performed using a standardized technique; transperineal ultrasound was performed in the supine position after voiding. 3D/4D volumes were obtained at rest, on pelvic floor contraction and on Valsalva using a GE Kretz Voluson 730 Expert system. Analysis of the datasets was undertaken using the software GE Kretz 4D view. Rectocele was diagnosed if there was a defect of the rectovaginal septum at the level of the anorectal junction; width and depth was measured. Enterocele was considered clinically relevant if there was a herniation of bowel of more then one-third into the rectovaginal septum. Offline analysis was performed with two experienced investigators blinded against the results of the other method. Complete datasets of 68 patients were available. Rectocele was diagnosed in 33 patients with CCD and in 33 patients with transperineal ultrasound; k = 0.65 (positive agreement in 83%). For enterocele Cohen's kappa was 0.61, 14 in patients with CCD and 14 in patients with ultrasound (93% positive agreement). For intussuseption there was a poor level of correlation (k = 0.27). This study shows good agreement for detecting rectocele and enterocele between CCD and 3D/4D ultrasound investigation. For detecting pelvic organ anatomical abnormalities 3D/4D ultrasound investigation may be considered as the gold standard for assessment.