Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2017; 23(31): 5732-5738
Published online Aug 21, 2017. doi: 10.3748/wjg.v23.i31.5732
Hypothesized summative anal physiology score correlates but poorly predicts incontinence severity
Christopher J Young, Assad Zahid, Cherry E Koh, Jane M Young
Christopher J Young, Assad Zahid, Cherry E Koh, Department of Colorectal Surgery, University of Sydney, Sydney, NSW 2042, Australia
Christopher J Young, RPAH Medical Centre, Sydney, NSW 2042, Australia
Christopher J Young, Assad Zahid, Discipline of Surgery, University of Sydney, Sydney, NSW 2042, Australia
Cherry E Koh, Jane M Young, Surgical Outcome Research Centre (SOuRCe), Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW 2042, Australia
Jane M Young, School of Public health, University of Sydney, Sydney, NSW 2006, Australia
Author contributions: Young CJ, Koh CE and Young JM designed the research; Young CJ, Zahid A, Koh CE and Young JM performed the research; Young CJ and Zahid A contributed new ideas to the manuscript publications; Koh CE and Young JM analyzed the data; Young CJ, Zahid A, Koh CE and Young JM wrote the paper.
Institutional review board statement: This study proves by University of Sydney Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of them has received fees for serving as a speaker, or been a consultant and/or an advisory board member for any organization(s). None has received research funding for this project. None owns stocks and/or shares relevant to this research. None owns any patents
Data sharing statement: No additional data are 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: Dr. Christopher J Young, Professor, RPAH Medical Centre, Suite 415, 100 Carillon Avenue, Sydney, NSW 2042, Australia. cyoungnsw@aol.com
Telephone: +61-2-95197576 Fax: +61-2-95191806
Received: March 13, 2017
Peer-review started: March 14, 2017
First decision: May 16, 2017
Revised: June 14, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: August 21, 2017
Processing time: 158 Days and 22.9 Hours
Abstract
AIM

To explore the relationship between such a construct and an existing continence score.

METHODS

A retrospective study of incontinent patients who underwent anal physiology (AP) was performed. AP results and Cleveland Clinic Continence Scores (CCCS) were extracted. An anal physiology score (APS) was developed using maximum resting pressures (MRP), anal canal length (ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed.

RESULTS

Of 508 (419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mmHg (SD 23.2 mmHg) for men and 39 mmHg (19.2 mmHg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP (P = 0.0002), ACL (P = 0.0006) and pudendal neuropathy (P < 0.0001). The association between APS and CCCS was significant (P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%.

CONCLUSION

This study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores.

Keywords: Incontinence; Anal physiology; Anal canal; Anal ultrasound; Manometry; Electromyography

Core tip: This study explored the relationship between a hypothesized anal physiology score combining rankings from maximal manometric resting pressures and anal canal length, ultrasound proportions of anal canal length of internal and external anal sphincters which were intact, and bilateral pudendal nerve terminal motor latencies; with the Cleveland Clinic Continence Score. The association between physiology and continence scores was significant but accounted for only 9.2% of the variability. The most useful variables predicting continence score were proportion of external sphincter intact, pudendal neuropathy and previous pelvic surgery. This study shows anal physiology tests predict continence scores better when considered collectively.