SPHINCTEROMETRY GRADATION OF ANAL SPHINCTER INSUFFICIENCY

PURPOSE. To determinate manometric parameters for different degrees of anal sphincter insufficiency (ASI) by the non-perfusion water sphincterometry with measurement device WPM Solar (MMS, The Netherlands). METHODS. The study included 228 patients with complaints of incontinence of various components of the intestinal contents. Among them were 94 (41,2%>) men, mean age 47,3±16,8 year, 134 (58,8%) women, mean age 49,1±15,9 year. The patients were divided according to the clinical classification of anal sphincter insufficiency (ASI) developed by Russian State Research Center of Coloproctology. Grade I was present in 112 (49,1%) patients complaining of gas incontinence. Grade II - in 80 (35,1%) patients with gas and liquid incontinence. Grade III - in 36 (15,8%) patients with all components incontinence. The Cleveland Clinic (Wexner) fecal incontinence score applied to all patients as the subjective assessment of the severity ASI. For an objective assessment of the anal sphincter insufficiency used sphincterometry. RESULT. This study has allowed to build a reliable reference intervals manometric and score (Wexner scale) parametrs for all grades ASI, separately for men and women First grade ASI (male/female): mean resting pressure - 32,8-42,0 / 36,3-40,0 mm Hg, max. squeeze pressure -115,0-120,0 / 97,4-109,0 mm Hg, mean squeeze pressure - 89,5-105,0 / 68,8-87,0 mm Hg, squeeze gradient - >79,5 / 73,6 mm Hg, score -<4,2 / <6,3. Second grade ASI (male/female): mean resting pressure - 25,3-32,7 / 26,9-36,2 mm Hg, max. squeeze pressure - 74,9-114,9 / 61,9-97,3 mm Hg, mean squeeze pressure - 53,0-89,4 / 46,0-68,7 mm Hg, squeeze gradient 49,9-77,0 / 35,9-58,0 mm Hg, score - 4,3-10,1 / 6,4-10,7. Third grade ASI (male/female): mean resting pressure - <25,2 / <26,8 mm Hg, max. squeeze pressure - <74,8 / <61,8 mm Hg, mean squeeze pressure - <52,9 / 45,9 mm Hg, squeeze gradient < 49,8 / 35,8 mm Hg, score - >10,2 / > 10,8.

sphincterometry, continence mechanism, anal sphincter insufficiency, anorectal manometry

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