Three-dimensional high-resolution anorectal manometry: A comparative pilot study with X-ray defaecography

Three-dimensional high-resolution anorectal manometry (3DHRAM) is a new technique that can explore anorectal disorders and provide interesting topographic data for the diagnosis of pelvic floor disorders such as paradoxical puborectalis syndrome (PPS). Our object was to evaluate whether 3DHRAM can reliably diagnose PPS already diagnosed with X-ray defaecography, which is considered to be the gold standard. All patients being tested in our department for dyschezia by 3D-HRAM and X-ray defecography were eligible for the study. The 3DHRAM results were compared with X-ray defecography. The sensitivity, specificity, and positive and negative predictive values were calculated for various 3DHRAM criteria to propose a diagnostic strategy for PPS. Twenty-three patients presented with PPS on X-ray defaecography. On 3DHRAM, according to our diagnostic strategy, the kappa value was 0.706, with a positive predictive value of 71.88% [95% CI, 53.02-85.60], a specificity of 80.43% [95% CI, 65.62-90.13], a sensibility of 95.83% [95% CI, 76.98-99.78], and area under curve value was 0.922. In this study, 3DHRAM was used to diagnose PPS with the same degree of reliability as X-ray defaecography, and we confirmed its use in the diagnosis of pelvic floor disorders. Further studies will be necessary to define classifications for these new anatomic data from 3DHRAM.