Correlação entre a ecodefecografia e a ultrassonografia endovaginal dinâmica tridimensional na detecção de descenso perineal em mulheres com sintomas de evacuação obstruída

• Ano de defesa: 2019
• Autor(a) principal: Veras, Lara Burlamaqui
• Orientador(a): Regadas, Sthela Maria Murad
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: Evacuação; Diafragma da Pelve; Canal Anal
• Link de acesso: http://www.repositorio.ufc.br/handle/riufc/41836

Objective: Describing a new three-dimensional (3D) dynamic endovaginal ultrasonography (EVUS) technique for evaluating perineal descent (PD), comparing it with Ecodefecography (ECD) and correlating with anatomical and functional abnormalities of the pelvic floor (PF). Method: A cross-sectional study whose sample consisted of women with obstructed evacuation symptoms evaluated with Cleveland Clinic Florida (CCF) constipation score, whether faecal incontinence (FI) or urinary (UI) were present and submitted to ECD and USEV. Women were distributed according to the PD in ECD. GI-normal PD (puborectalis muscle displacement - PR≤2.5cm) e GII- excessive PD (PR displacement > 2,5cm). In the USEV, PD was determined according to displacement and position of the anorectal junction (ARJ), comparing rest with Valsalva maneuver. FI and/or UI and anatomical and functional alterations of the PF were correlated with PD. Results: 61 women with obstructed evacuation symptoms and CCF score > 6 were included. GI-29 (2 nulliparous and 27 women with prior vaginal delivery-VD), mean age 59 years. Of these, in 27 the ARJ displacement ≤1cm (mean: 0.6cm, variation: 0.1-1cm) and the mean ARJ position was 0.6cm (0-2.3cm) above pubic symphysis (PS) in Valsalva maneuver by the EVUS. GII-32 (1 nulliparous and 31 VD), mean age 60 years. Of these, PD was identified in 30 patients by the USEV: in 24 the mean ARJ position was 0.4cm (0.3-2.4cm) below the PS and the mean ARJ displacement was 1.4 cm (0.4-3.6cm). In 6, the ARJ displacement > 1cm (mean = 1.3cm / 1.2-1.7cm) and the ARJ position was 0.4cm (0-0.8cm) above PS. The κ statistic showed almost perfect agreement (κ = 0,86) between the two methods. Conclusion: USEV is a reliable technique for evaluating PD, with high agreement with ECD. Excessive PD can be defined as ARJ displacement > 1 cm and/or its position below PS in Valsalva maneuver. There was no correlation between PD and FI, UI or anatomical and functional abnormalities of the PF. Keywords: Perineal descent. Obstructed defecation. Ecodefecography. Endovaginal Ultrasonography.