Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2017; 23(21): 3900-3906
Published online Jun 7, 2017. doi: 10.3748/wjg.v23.i21.3900
Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia
Ya-Hong Xue, Shu-Qing Ding, Yi-Jiang Ding, Li-Qun Pan
Ya-Hong Xue, Shu-Qing Ding, Yi-Jiang Ding, The National Anorectal Medicine Center of Chinese Medicine, the Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210001, Jiangsu Province, China
Li-Qun Pan, Nanjing University of Traditional Chinese Medicine, Nanjing 210046, Jiangsu Province, China
Author contributions: Ding YJ and Pan LQ contributed equally to this work and should be considered as co-corresponding authors; Xue YH performed the three-dimensional endoanal ultrasound examination, collected and analyzed the data, and wrote the paper; Ding SQ advised on the design and performance of the study; Ding YJ designed the study and provided the foundation; Pan LQ participated in the design of the study and is responsible for the paper’s reliability.
Supported by the State Administration of Traditional Secretary and the Nanjing Health Bureau, No. YKK12142.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of Nanjing Chinese Medicine Hospital Ethics Committee in China.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Li-Qun Pan, MD, PhD, Nanjing University of Traditional Chinese Medicine, No.138 Xianlin Avenue, Nanjing 210046, Jiangsu Province, China. cr_ane@163.com
Telephone: +86-18951755197 Fax: +86-25-52276740
Received: November 14, 2016
Peer-review started: November 15, 2016
First decision: January 10, 2017
Revised: February 7, 2017
Accepted: March 31, 2017
Article in press: March 31, 2017
Published online: June 7, 2017
Processing time: 205 Days and 6.8 Hours
Abstract
AIM

To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP).

METHODS

In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups.

RESULTS

Patients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 ± 3.59 mm vs 28.87 ± 4.84 mm, P < 0.05 and 9.67 ± 1.57 mm vs 8.85 ± 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23° ± 1.81° vs 89.94° ± 2.07° in control group, P < 0.05) and straining (88.47° ± 3.32° vs 90.72° ± 1.87° in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23° ± 1.81° vs 88.47° ± 3.32° respectively, P > 0.05).

CONCLUSION

The association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.

Keywords: Chronic proctalgia; Three-dimensional endoanal ultrasound; Puborectalis angle; Internal anal sphincter; Puborectalis muscle

Core tip: This study prospectively evaluated the anal sphincter morphology and function of chronic proctalgia (CP) in female patients by three-dimensional endoanal ultrasound. Here, we employed puborectalis angle to assess the paradoxical contraction of the puborectalis muscle (PR) in CP. The PR thickness and paradoxical contraction of PR are associated with CP, which may be promising diagnosis factors for CP.