Diagnostic capabilities of transperineal ultrasound (TPUS) to evaluate anal sphincter defect post obstetric anal sphincter injury (OASIS)? A systematic review

Abstract

Introduction Endoanal ultrasound (3D-EAUS) is the gold standard imaging investigation for evaluating the anal sphincter; unfortunately, it is not universally available in most obstetric units. This study aims to appraise the ability of transperineal ultrasound (TPUS) compared with 3D-EAUS as the gold standard to identify anal sphincter defects after primary repair of OASIS. Methods A systematic search of major databases to identify diagnostic accuracy of 3D-TPUS in evaluating anal sphincter defects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were designed for this systematic review. The risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Our eligibility criteria are patients with a history of primary repair of anal sphincter injuries (OASIS). They were followed up after the primary repair to detect the anal sphincter defect using 3D-TPUS vs. 3D-EAUS as a gold standard. Results Two eligible observational studies were included and assessed for risk of bias using the QUADAS-2 tool and showed a low risk of bias and a low risk of concerns. 3D-TPUS had various sensitivity to detect external anal sphincter defects in two studies; meanwhile, the specificity was around 67–70%. For detecting the internal anal sphincter defects, 3D-TPUS had low sensitivity but high specificity (93–94%). Conclusion 3D-TPUS had various sensitivity to detect external anal sphincter defects and low sensitivity to detect internal anal sphincter defects. On the other hand, 3D-TPUS had low specificity for detecting external anal sphincter defects and high specificity for detecting internal anal sphincter defects.

Three-Dimensional Transperineal Ultrasound Guiding Early Secondary Repair of Obstetric Anal Sphincter Injury in an Incontinent Patient without Suture Dehiscence

“…While early secondary repair in the case of suture dehiscence has been investigated [ 16 ], indications regarding symptomatic cases without suture dehiscence are lacking. In recent years, 3D transperineal ultrasound (TPUS) has been successfully used to diagnose OASIs and monitor the healing process [ 17 ], achieving good sensitivity and high specificity in identifying EAS and IAS defects, respectively [ 18 ]. It also has the advantages of lower cost, greater availability in gynecological clinics, and higher tolerability [ 12 ] than endoanal ultrasound (EAUS), which has been the gold standard so far [ 14 , 19 ].…”

“…In the case we presented, complete anal incontinence was not associated with either urinary symptoms or primary suture dehiscence. However, we believe that this symptom is so disabling that the diagnostic and therapeutic procedure must be immediately activated [ 18 ]. Although a gradual spontaneous reduction in symptoms has been reported over the years following delivery, there is consensus that patients with severe impairment are candidates to early repair [ 20 ].…”