Vektorvolumenmanometrie in der Diagnostik des Descending-Perineum-Syndroms

Background and Purpose: The syndrome of the descending perineum (DPS) was described in 1966 as a synonym for complex pelvic floor malfunctions. Today, there are many different techniques for the diagnosis of pelvic floor dysfunction. A well-planned stepwise diagnostis is important in order to obtain all necessary information without wasting resources. The goal of this study was to examine the role of manometry in the diagnosis of DPS. Patients and Methods: For study purposes, female patients with clinically and radiologically proven DPS were compared with a healthy control group. During the standardized investigation, a digital examination, an endoanal ultrasound and a neurophysiological examination with measurement of the pudendal nerve terminal motor latency and testing of the anorectal reflex were done after detailed anamnesis including continence score. In the same investigation the vector-volume manometry was performed as perfusion pull-through manometry. Results: A total of 72 female patients, 47 women in the DPS group and 25 in the control group, were examined. Comparison of resting pressures revealed no significant difference (p = 0.053), whereas the average of resting pressures was lower in DPS patients. Also, the squeezing pressures were not significantly different between the groups. Comparison of resting and squeezing vector-volume data did not show significant differences either. The functional sphincter length was significantly shorter in DPS patients. Also, the sphincter length difference was significantly different (p < 0.001) between the groups. A significant decrease of the squeezing high-pressure zone (p < 0.01) occurred in the DPS group. Conclusion: The constellation with shortening of the functional length of the sphincter and the high-pressure zone in squeezing and reduced sphincter length difference is a clear indication of DPS. The vector-volume manometry can be an important diagnostic step before taking the expensive ones.