Dynamic cystoproctography and physiological testing in women with urinary stress incontinence and urogenital prolapse

In order to determine the frequency of posterior compartment pathology in females with anterior and middle compartment pelvic floor weakness, 10 women with urinary stress incontinence and 10 women with uterovaginal prolapse underwent detailed review of their history and clinical findings, and were studied by simultaneous evacuation proctography and cystography. Radiological findings were correlated with anorectal physiological testing. Considerable symptom overlap and occult defaecatory symptoms were revealed. The combined radiological examination visualized cystocoele, enterocoele, rectocoele and rectal intussusception, and diagnosed higher degree prolapse than did clinical examination. There was no significant difference in the frequency of any of these findings with respect to either group, nor was there any significant difference in proctographic measurements. Additionally, there was little significant difference in physiological measurements between the groups, and when cystoproctographic features were compared to the results of anorectal physiological testing, there was little correlation between results obtained from either set of tests. In conclusion, modification of standard proctographic techniques enhances the diagnostic potential of the study, allowing accurate demonstration of the site and degree of pelvic floor weakness in women. Weakness often involves all pelvic compartments, despite differing clinical presentations, suggesting a global pathology. Embarrassing symptoms may not be volunteered, and should be sought so that imaging is appropriate.