Pressure Values And Topography Of Rectocele By 3-dimensional High Resolution Anorectal Manometry

Objective To evaluate the 3D anorectal pressure topography(3D-ARPT) of normal healthy women volunteers and patients with rectocele and patients with outlet obstructed constipation(OOC) using a novel 3-dimensional high resolution manometry 3D-HRM) of anorectum. Then,we analysis and comparison the date of the anorectal pressure, expect to explore further indicated the mechanism of rectocel. At present, rectocele of diagnosis depend mainly on defecation imaging, but it was relatively fussy and it was complained by patients with the pain, so this study also to prove whether the 3D-HRM can become an important methods of the diagnosis of rectocele. Through this test also can detect the relationship between the outlet obstructive constipation and rectocele( the rectocele is the etiology of the OOC or the OOC is the etiology of rectocele).Methods The 3D-HRM probe contains a 6.4cm long sensing segment that is composed of 256 independent pressure transducers around its circumference. With working it produces a 3D pressure topgraphic profile of the anorectum. We evaluated 46 healthy women(median age 52 years), and compared them with 129 obstructed defaecation syndrome(ODS) patients with rectocele(median age 55 years) and 22 ODS patients without rectocele(median age 55 years). The 3D anorectal pressure topography was evaluated at rest, during squeeze, stimulated defecation and balloon inflation time,what is more, it contains the balloon out of time.Results In this study, we can see not only maximum resting pressure, mean resting pressure, high pressure zone length, residual anal pressure but also rectoanal pressure differential were significantly higher in patients with rectocele compared with healthy adults women volunteers(P<0.05 each). What is more, the balloon expulsion time(s) was significantly slower in the rectocele patients compared with healthy adults women volunteers(P< 0.01). With the anal contraction, the 2D-anorectal pressure topography of patients with rectocele presents a characteristic “boots-shaped change”. Compared with healthy women volunteers, there was a low pressure in the anal canal during stimulated defecation in patients with rectocele. We divided the 151 patients with OOC into simple OOC patients, rectocele by less than 2 cm and rectocele exceed 2 cm three groups, analysis and comparison the date of the anorectal pressure,.It turned out that three groups had no obvious difference.Conclusion The 3D-HRM technique could more intuitively evaluate the rectocele, provide some help for doctors to diagnose disease, become an auxiliary examination to diagnose rectocele, further demonstrates the value of manometry in terms of diagnosis, further indicated the mechanism of rectocele. In addition, there is no direct data to prove that the rectocele is the cause of the outlet obstructed constipation, on the contrary, we guess that outlet obstructive constipation is the cause of rectocele.