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The patient's experience of defaecating proctography: Comparing magnetic resonance with conventional fluoroscopy
R Prasad1, K Gelder1, R Wiles1
1Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
Introduction:
Fluoroscopy and MRI are currently used to investigate defaecation and pelvic floor dysfunction, with advantages and disadvantages to both modalities. Anecdotally it is suspected that MRI, allowing more privacy, may be better tolerated by patients but that symptoms may be more easily replicated with fluoroscopic technique due to the physiological position. The aim of this study was to evaluate the patient experience of both techniques to potentially help guide the choice of defaecating proctography modality in the future.
Methods:
This prospective study was conducted June 2015-March 2017 in a large teaching hospital. Patients undergoing fluoroscopy (FDP) or MR defaecating proctography (MRDP) completed a post-procedure questionnaire rating their satisfaction (1-5, 5 being most satisfied) of different aspects of the test.
Results:
24 patients underwent FDP and 17 MRDP. Both procedures were scored highly in general for all questions with mean >4.1 and median 5, out of 5. Though not statistically significant, the mean scores for all aspects of the test were slightly higher for fluoroscopy than MR. As well as scoring higher for comfort (4.8 vs 4.4) and dignity maintained (4.6 vs 4.1), the patients who underwent fluoroscopy thought it was easier to replicate symptoms than the patient who underwent MR defaecating proctography (4.6 vs 4.2).
Conclusion:
This study shows that both FDP and MRDP are well tolerated in the investigation of defaecation and pelvic floor dysfunction. FDP was scored consistently higher than MRDP, but this was not statistically significant. Thus, this study suggests that patient tolerance of the test is unlikely to be any worse for FDP than for MRDP. Clinicians and radiologists should take into account risks of radiation exposure as well as potential for surgical management when making their decision as to which test is appropriate. The authors recommend that if the patient is unable to replicate their symptoms in MRDP, fluoroscopy should be performed to ensure significant pathology is not being missed.
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