Reading too much into anal vector volumetric parameters: correspondence for 'Anal vector volume analysis: an effective tool in the management of pelvic floor disorders' M. Grande, F. Cadeddu, P. Silveri, P. Ciano, G. M. Attina, I. Selvaggio, G. Milito. Tech Coloproctol (2011) 15:31-37.

摘要

Dear Sir, Grande and colleagues are to be congratulated for a detailed vector volumetric analysis of an unselected group of patients presenting with hypotonia, normotonia and hypertonia discovered initially with conventional mano-metric assessment [1]. Their finding of a greater degree of resting and squeeze vectorial asymmetry in incontinent and rectal prolapse patients is somewhat expected, where in the former group, there was a high incidence of ultrasono-graphically detected internal and external anal sphincter defects, and in the latter group, over half the patients had an abnormally large asymmetric index (as defined by the authors). What we do not know from this study is whether the locale of the asymmetry correlates with that of the detectable sphincter defect (s) or whether prolapse is just a clinical representation of worsening grades of global or sectorial hypotonia in patients who over time probably represent patients with an inherent pudendal neuropathy and presacral plexopathy. It would be nice if the first finding was true but our group has already shown that sectorial pressures, whilst being globally different between the 3 groups of patients, (as identified by conventional manometry), do not show regional differences when represented by vector analysis [2]. Here, the trend is for global but not sectorial differences as one moves from incontinent, through rectal prolapse to normal patients and then onto hypertonic groups, making the diagnostic value of vector volume manometry as an advance over conventional manometry rather suspect [3].