Lester Tsai, MD, David Kunkel, MD; University of California San Diego, San Diego, CA
Introduction: 3D Transrectal ultrasound (TRUS) is a non-invasive diagnostic modality that can assess the structure of the pelvic floor musculature. While structural defects are frequently seen in women with fecal incontinence (FI), TRUS findings among men with FI are less clear. In this study, we investigated the utility and clinical implications of TRUS on the management of FI in men. Methods: We conducted a retrospective review of 90 consecutive patients who underwent TRUS imaging at an open access motility lab between August 2015 to November 2019. Baseline characteristics such as sex, age, and body mass index, were recorded. TRUS data included indication for study, pelvic floor hiatus length at rest and with squeeze, and presence or absence of a defect in the external anal sphincter, internal anal sphincter, puborectalis muscle, and perineal body. Anorectal physiologic studies were also reviewed. Data on resting sphincter pressure, squeeze sphincter pressure, squeeze endurance, dyssynergia, rectal sensation, and balloon expulsion time were collected. Results: Among 90 patients, 16 were men and 74 were women. Half of male patients had no muscle defects, 31% had one defect, and 19% had two or three defects. Within the female cohort, 18% of females had no muscle defects, while 82% of women had at least one muscle defect. Among males with muscle defects, past medical history was significant for prostate cancer with chemoradiation or prostatectomy, rectal cancer with chemoradiation or proctectomy, hemorrhoidectomy, surgical repair of imperforate anus, and prostatic laser treatment. Among men with no muscle defects, available anorectal physiologic studies revealed a dyssynergic pattern in 80% and normal findings in 20% of the patients. Discussion: This study highlights a valuable role for TRUS in men with FI. The proportion of men, in contrast to that of women, with any muscular defect was much lower (i.e., 50% versus 82%) and often secondary to iatrogenic causes. When men were found to have no muscle defects on TRUS, this reliably ruled out weakness and predicted an 80% chance of a rectal evacuation disorder. The data obtained from TRUS can allow the clinician to target effective therapies for men with FI.
Disclosures: Lester Tsai indicated no relevant financial relationships. David Kunkel indicated no relevant financial relationships.