Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Sultan AH. Editorial: Obstetrical perineal injury and anal incontinence. Clin Risk. 1999;5(6):193–196. doi: 10.1177/135626229900500601. - DOI
    1. Holly R, Charles WN, Kathryn LB, Ryan W, Alison W, Joseph S, et al. Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. 2015;21(4):182–189. doi: 10.1097/SPV.0000000000000160. - DOI - PMC - PubMed
    1. Annette JR, Andrew DB, Abdul HS, Anne-Marie R, Ranee T. Outcome of repair of obstetric anal sphincter injuries after three years. Int J Gynecol Obstet. 2014;127:47–50. doi: 10.1016/j.ijgo.2014.04.013. - DOI - PMC - PubMed
    1. Roos AM, Thakar R, Sultan AH. Outcome of primary repair of obstetric anal sphincter injuries (OASIS): Does the grade of tear matter? Ultrasound Obstet Gynecol. 2010;36(3):368–374. doi: 10.1002/uog.7512. - DOI - PubMed
    1. Abrams P, Cardozo L, Khoury S, Wein A. Assessment and Conservative Management of Faecal Incontinence and Quality of Life in Adults. In: 5th International Consultation on Incontinence. Paris; 2013. p. 1443–86.

Publication types

LinkOut - more resources