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The use and impact of defaecating proctrograms - could less be more?

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The use and impact of defaecating proctograms –  could less be more?

E Decker, A Moore, M McFall

Worthing Hospital, Western Sussex NHS Trust, UK

INTRODUCTION:

Dynamic investigations of pelvic floor function are integral to the assessment of pelvic floor disorders, including obstructive defecation syndrome (ODS) and rectocele. Traditionally this includes a defaecating proctograms (DP), which some patients find embarrassing. Additionally pathology identified through DP may be apparent on history and examination alone. 

We audited the impact of DP on the management of defaecatory disorders in a DGH without a subspecialist pelvic floor service. 

METHODS:

DP performed between January 2014  to September 2017 were identified from the radiology database.

Hospital records were evaluated for presenting symptoms, examination findings, indications on request forms and subsequent

management. Details of the referrer including specialty and seniority were also recorded.

AIM

Aims of the study were:

•Assess the quality of information provided to the radiologist interpreting the images
•Identify if DP’s change the final management for the patient.
 
RESULTS
1) who requests DP
       (CHART)
2) who gets DP
   
•99 proctograms were performed
•Reported by 2 radiologists
•97% of patients were female
•Median age 57 years (range 22 – 87)
 
 
3) what are the indications 
      (CHART)  The clinical details on the request forms were largely inadequate
 
4) What did the DP show?

Confirmed:

•Intussusception in 33 of 81 (41%) referred with OD
•Rectocele in 34/58 (63%) patients with suspected rectoceles. 
•5% of DP were normal
•8 failed due to incontinence 
 
5) What were the outcomes? 

Overall concordance with clinical query was 55%

40 inter-speciality referrals were made: largely from surgery to gynaecology.

17 patients underwent surgery, 3 declined an operation, 9 had physiotherapy referrals.

No documented change in management occurred in 50%.

 

DISCUSSION/ CONCLUSION

DP requests were frequently made with inadequate clinical details, often by non-consultant staff and importantly did not result in change in management. DP might be rationalized by limiting requests to senior clinicians and by more stringent patient selection. 

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