DSpace Repository :: Browsing by Author "Kamisan, Ixora"

Browsing by Author "Kamisan, Ixora"

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Anal sphincter trauma and anal incontinence in urogynecological patients
(2015) Guzmán Rojas, Rodrigo; Kamisan, Ixora; Shek, Ka Lai; Dietz, Hans
OBJECTIVES: To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma. METHODS: This was a retrospective analysis of ultrasound volume datasets of 501 patients attending a tertiary urogynecological unit. All patients underwent a standardized interview including determination of St Mark's score for those presenting with AI. Tomographic ultrasound imaging (TUI) was used to evaluate the EAS and the internal anal sphincter (IAS). RESULTS: Among a total of 501 women, significant EAS and IAS defects were found in 88 and 59, respectively, and AI was reported by 69 (14%). Optimal prediction of AI was achieved using a model that included four abnormal slices of the EAS on TUI. IAS defects were found to be less likely to be associated with AI. In a multivariable model controlling for age and IAS trauma, the presence of at least four abnormal slices gave an 18-fold (95% CI, 9-36; P < 0.0001) increase in the likelihood of AI, compared with those with fewer than four abnormal slices. Using receiver-operating characteristics curve statistics, this model yielded an area under the curve of 0.86 (95% CI, 0.80-0.92). CONCLUSIONS: Both AI and significant EAS trauma are common in patients attending urogynecological units, and are strongly associated with each other. Abnormalities of the IAS seem to be less important in predicting AI. Our data support the practice of using, as a minimal criterion, defects present in four of the six slices on TUI for the diagnosis of significant EAS trauma.
Defect-specific rectocele repair: medium-term anatomical, functional and subjective outcomes.
(The Royal Australian and New Zealand College of Obstetricians and Gynaecologists by Wiley, 2015) Guzmán Rojas, Rodrigo; Kamisan, Ixora; Shek, Ka Lai; Dietz, Hans
BACKGROUND: Rectocele is a herniation of the anterior wall of the rectal ampulla through a defect in the rectovaginal septum causing protrusion of the posterior vaginal wall. Common symptoms include symptoms of prolapse and obstructed defecation. AIMS: To describe subjective, anatomical and functional results of defect-specific rectocele repair. MATERIALS AND METHODS: This is an internal audit of 137 women who underwent defect-specific rectocele repair. Pre- and post-operative assessment included a standardised interview, clinical examination and 3D/4D transperineal ultrasound. Outcome measures were symptoms of obstructed defecation, recurrent prolapse symptoms, clinical posterior compartment recurrence and rectocele recurrence on ultrasound. RESULTS: At a mean follow-up of 1.4 years, 117 (85%) of women considered themselves cured or improved. Thirty-four (25%) complained of recurrent prolapse symptoms and 47 (34%) symptoms of obstructed defecation, a significant reduction (P < 0.0001). Clinical recurrence (Bp ≥ -1) was seen in 19 women (14%) and recurrence on ultrasound in 27 (20%). The mean depth of recurrence was 16.6 mm (10.3-25.1). We tested multiple potential predictors of recurrence, including age, BMI, vaginal parity, previous hysterectomy and/or prolapse surgery, follow-up time, pre-operative clinical and ultrasound findings. Only hiatal area on Valsalva (OR 0.95 for sonographic recurrence, P = 0.01) and enterocele (for clinical and sonographic recurrence, OR 4.03, P = 0.01 and OR 2.72, P = 0.02, respectively) reached significance. CONCLUSION: Defect-specific rectocele repair is effective both in restitution of normal anatomy and in resolving prolapse and obstructed defecation symptoms at a mean follow-up of 1.4 years.
Digitation associated with defecation: what does it mean in urogynaecological patients?
(IUGA with Springer International Publishing AG, 2016) Hai-Ying, Cao; Guzmán Rojas, Rodrigo; Caudwell, Jessica; Kamisan, Ixora; Dietz, Hans
INTRODUCTION AND HYPOTHESIS: Obstructed defecation is a common symptom complex in urogynaecological patients, and perineal, vaginal and/or anal digitation may required for defecation. Translabial ultrasound can be used to assess anorectal anatomy, similar to defecation proctography. The aim of the present study was to determine the association between different forms of digitation (vaginal, perineal and anal) and abnormal posterior compartment anatomy. METHODS: A total of 271 patients were analysed in a retrospective study utilising archived ultrasound volume datasets. Symptoms of obstructed defecation (straining at stool, incomplete bowel emptying, perineal, vaginal and anal digitation) were ascertained on interview. Postprocessing of stored 3D/4D translabial ultrasound datasets obtained on maximal Valsalva was used to diagnose descent of the rectal ampulla, rectocoele, enterocoele and rectal intussusception at a later date, blinded to all clinical data. RESULTS: Digitation was reported by 39 % of our population. The position of the rectal ampulla on Valsalva was associated with perineal (p = 0.02) and vaginal (p = 0.02) digitation. The presence of a true rectocoele was significantly associated with perineal (p = 0.04) and anal (p = 0.03) digitation. Rectocoele depth was associated with all three forms of digitation (P = 0.005-0.02). The bother of symptoms of obstructed defecation was strongly associated with digitation (all P < = 0.001), with no appreciable difference in bother among the three forms. CONCLUSION: Digitation is common, and all forms of digitation are associated with abnormal posterior compartment anatomy. It may not be necessary to distinguish between different forms of digitation in clinical practice.
Negative urodynamic testing in women with stress incontinence.
(The Royal Australian and New Zealand College of Obstetricians and Gynaecologists by Wiley, 2015) Liversidge, Kylie; Guzmán Rojas, Rodrigo; Kamisan, Ixora; Dietz, Hans
INTRODUCTION: A minority of women with a subjective complaint of stress urinary incontinence will have negative urodynamic stress incontinence (USI) findings. AIM: To test clinical and ultrasound measures as predictors of an unexpected absence of USI. We hypothesised that unexpectedly negative USI would be more common in young women with good pelvic floor and urethral function. METHODS: A retrospective study analysing 398 data sets from women attending a urogynaecology clinic for evaluation of lower urinary tract and pelvic floor dysfunction. Clinical, urodynamic and translabial ultrasound data were tested as possible predictors of negative USI findings. RESULTS: Women with unexpectedly negative USI findings were younger, had less anterior compartment prolapse and had a higher maximum urethral pressure. Measures of pelvic floor muscle function were not predictive. CONCLUSIONS: Women with unexpectedly negative USI are younger and have better urethral function, but voluntary pelvic floor muscle function seems unrelated to this phenomenon.
The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients
(Springer, 2016) Guzmán Rojas, Rodrigo; Kamisan, Ixora; Shek, Ka Lai; Dietz, Hans
INTRODUCTION AND HYPOTHESIS: Symptoms of obstructive defecation (OD) are common in women. Transperineal ultrasound (TPUS) has been used for the evaluation of defecatory disorders. The aim of our study was to determine the overall prevalence of anatomical abnormalities of the posterior compartment and their correlations with OD in women seen in a tertiary urogynecology clinic. METHODS: This is a retrospective study on 750 women seen at a tertiary urogynecological unit who had undergone a standardized interview, clinical examination, and 4D TPUS. Univariate and multivariate logistic regression analyses were undertaken to study the association between examination findings and symptoms of OD. This study was approved by the local human research ethics committee (Nepean Blue Mountains Local Health District Human Research Ethics Committee, IRB approval no. 13-16). RESULTS: The datasets of 719 women were analyzed. Mean age was 56.1 (18.4-87.6) years. Ninety-seven patients (13 %) reported fecal incontinence, 190 (26 %) constipation, and 461 (64 %) symptoms of OD. On examination, 405 women (56 %) were diagnosed with significant posterior compartment prolapse (POP-Q ≥ stage 2), which was associated with symptoms of OD (p < 0.0001). On ultrasound, 103 (14 %) patients had an enterocele, 382 (53 %) a true rectocele and 31 (4.3 %) had rectal intussusception. On multivariate analysis true rectocele (p = 0.003) and rectal intussusception (p = 0.004) remained significantly associated with symptoms of OD. CONCLUSION: Both symptoms of OD and anatomical abnormalities of the posterior compartment are highly prevalent in urogynecological patients. Ultrasound findings of a true rectocele and rectal intussusception are significantly associated with obstructed defecation.
The repeatability of sonographic measures of functional pelvic floor anatomy.
(IUGA with Springer International Publishing AG, 2015) Tan, Li; Shek, Ka Lai; Kamisan, Ixora; Guzmán Rojas, Rodrigo
Translabial 3D/4D ultrasound is increasingly being used in the diagnostic evaluation of pelvic floor dysfunction. The result of the assessment is influenced by a number of confounders that are generally unrecognised. The aim of this study was to determine the short- to medium-term repeatability of translabial ultrasound measures of female pelvic organ support and pelvic floor anatomy. METHODS: This is a retrospective study analyzing archived ultrasound volume datasets of 106 patients with pelvic floor dysfunction. Every subject was assessed twice at an average interval of 73 days. Outcome measures including hiatal area on Valsalva, descent of the bladder neck, bladder, uterus and rectal ampulla, rectocele depth, diagnosis of true rectocele, and levator integrity (avulsion) were compared at the first and second appointments. RESULTS: All parameters of organ descent demonstrated good to excellent reliability (ICC 0.73-0.93) except for rectocele descent, which showed moderate reliability (ICC 0.44, CI 0.26-0.58). The most highly repeatable measure was hiatal area on Valsalva or "ballooning" (ICC 0.93, CI 0.90-0.95). For the diagnosis of levator avulsion and true rectocele, agreement was very high (kappa 0.91 for avulsion (CI 0.77-0.94) and kappa 0.73 (CI 0.56-0.84) for true rectocele). CONCLUSIONS: The short- to medium-term repeatability of translabial ultrasound measures of functional pelvic floor anatomy seems to be high. Hiatal area on Valsalva (ballooning) and diagnosis of levator avulsion were the most repeatable measures. The least repeatable measures related to the posterior compartment.
The ‘bother’ of obstructed defecation
(John Wiley & Sons, 2017) Alam, Pakeeza; Guzman, Rodrigo; Kamisan, Ixora; Robledo, Kristy; Dietz, Hans
OBJECTIVE: To examine the relationship of visual analog scale (VAS) 'bother' scores for obstructed defecation (OD) with demographic data, physical examination and sonographic findings of the posterior compartment. METHODS: All patients seen at a urogynecology clinic between January and October 2013 were included. Patients were diagnosed with OD if they had any of the following: incomplete bowel emptying, straining with bowel movement or need for digitation. Patients used a VAS to rate OD bother on a scale of 0-10 (0, no bother; 10, worst imaginable bother). For each patient, a comprehensive history was obtained, the International Continence Society Pelvic Organ Prolapse Quantification was performed and four-dimensional translabial ultrasound volumes were recorded on maximal Valsalva maneuver. Linear and multiple regression models were used to correlate bother VAS scores with demographic, clinical and sonographic findings. RESULTS: Among 265 patients included in the analysis, 61% had OD symptoms with a mean VAS bother score of 5.6. OD bother scores were associated with a history of previous prolapse surgery (P = 0.0001), previous hysterectomy (P = 0.0006), descent of the posterior compartment (Bp; P = 0.004) and hiatal dimensions (Pb and Gh + Pb; P = 0.006 and P = 0.004). OD bother was associated with the following sonographic findings: true rectocele (P = 0.01), depth of rectocele (P = 0.04), descent of rectal ampulla (P = 0.02), enterocele (P = 0.03) and rectal intussusception (P < 0.0001). CONCLUSIONS: VAS bother scores are associated with both clinical and sonographic measures of posterior compartment descent. Rectal intussusception was most likely to result in highly bothersome symptoms of OD. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Browsing by Author "Kamisan, Ixora"

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