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. 2023 Jun;26(2):393-399.
doi: 10.1007/s40477-022-00763-3. Epub 2023 Jan 11.

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

Surahman Hakim  1   2   3 , Budi Iman Santoso  1   2   3 , Suskhan Djusad  1   2   3 , Fernandi Moegni  1   2   3 , Raymond Surya  2   3 , Andrew Pratama Kurniawan  4   5
Affiliations

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

Surahman Hakim et al. J Ultrasound. 2023 Jun.

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.

Keywords: 3D endoanal ultrasound; 3D transperineal ultrasound; Anal sphincter defect; OASI; Perineal rupture; Ultrasound.

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Conflict of interest statement

There is nothing to declare.

Figures

Fig. 1
Fig. 1
PRISMA Model of literature searching
Fig. 2
Fig. 2
The studies risk of bias assessment using QUADAS-2
Fig. 3
Fig. 3
Forest plot of diagnostic capabilities of TPUS in detecting anal sphincter defect for external anal sphincter (EAS) and Internal anal sphincter (IAS)
See this image and copyright information in PMC

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