Characteristic Findings and Their Clinical Appraisal of Proctography and Cinedefecography in Patients with Pelvic Outlet Obstructive Disease.
- Author:
Kyong Rae KIM
1
;
Young Sok KIM
;
Soon Sup CHUNG
;
Chang Hee LEE
;
Gi Bong CHAE
;
Hye Rin ROH
;
Won Jin CHOI
;
Ung Chae PARK
Author Information
1. Department of Surgery, College of Medicine, Kon-kuk University, Chungju, Korea. gs3945@dreamwiz.com
- Publication Type:Original Article
- Keywords:
Proctography;
Cinedefecography;
Pelvic outlet obstructive disease
- MeSH:
Defecography;
Diagnosis;
Humans;
Intussusception;
Rectocele;
Retrospective Studies;
Sensitivity and Specificity
- From:Journal of the Korean Society of Coloproctology
2003;19(2):94-100
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We were assessed the characteristic findings of defecography and cinedefecography in patients with pelvic outlet obstructive disease, and compared the characteristic physiologic findings between proctography and cinedefecography. METHODS: Physiologic findings of 196 patients who were performed at least two items of physiologic tests were retrospectively evaluated. Patients were categorized as rectocele (Group I: n=119), nonrelaxing puborectalis syndrome (Group II: n=58), rectoanal intussusception (Group III: n=16), significant sigmoidocele (Group IV: n=3). The proctographic and cinedefecographic features were analyzed according to disease categories. The sensitivity, specificity, accuracy, false positive rate, false negative rate, diagnostic rate, and reproducibility were calculated, and we analyzed the difference between proctography and cinedefecography according to the disease groups. RESULTS: On the proctographic examinations; 1) 112 patients were confirmed as a clinically significant rectocele (n=128, sensitivity; 94%, specificity; 79%, accuracy; 88%, false positive rate; 21%, false negative rate; 6%, kappa; 0.749). 2) A clinically significant nonrelaxing puborectalis were 36 patients (n=73, sensitivity; 62%, specificity; 73%, accuracy; 70%, false positive rate; 27%, false negative rate; 38%, kappa; 0.328). 3) 12 patients were confirmed as significant rectoanal intussusception (n=31, sensitivity; 75%, specificity; 89%, accuracy; 88%, false positive rate; 11%, false negative rate; 25%, kappa; 0.425). 4) 3 patients were confirmed as clinically significant sigmoidocele (n=15, sensitivity; 100%, specificity; 94%, accuracy; 94%, false positive rate; 6%, false negative rate; 0%, kappa; 0.316). On the combination of proctography and cinedefecography; 1) 117 patients were confirmed as a clinically significant rectocele (n=122, sensitivity; 98%, specificity; 94%, accuracy; 96%, false positive rate; 6%, false negative rate; 2%, kappa; 0.925). 2) A clinically significant nonrelaxing puborectalis were 50 patients (n=64, sensitivity; 86%, specificity; 90%, accuracy; 88%, false positive rate; 10%, false negative rate; 14%, kappa; 0.738). 3) 16 patients were confirmed as significant rectoanal intussusception (n=22, sensitivity; 100%, specificity; 97%, accuracy; 97%, false positive rate; 3%, false negative rate; 0%, kappa; 0.826). 4) 3 patients were confirmed as clinically significant sigmoidocele (n=9, sensitivity; 100%, specificity; 97%, accuracy; 97%, false positive rate; 3%, false negative rate; 0%, kappa; 0.488). As compared with combined study (proctography plus cinedefecography), the proctography show decreased diagnostic rates in the evaluation of rectocele (P<0.05), nonrelaxing puborectalis (P<0.01), and rectoanal intussusception (P<0.05). And, the proctography also show increased false positive rate in the evaluation of rectocele (P<0.01), nonrelaxing puborectalis (P<0.01), and rectoanal intussusception (P<0.05). CONCLUSIONS: In our study, proctography showed a tendency to overdiagnosis. Therefore, the combined study of proctography and cinedefecography should be taken as a diagnostic tools for pelvic outlet obstructive disease. Adhering to these findings, other anorectal physiologic studies should be added for the clinically significant diagnosis.
