AIM: To determine the accuracy and predictive value of transperineal (TPU) and endovaginalultrasound (EVU) in the detection of anal sphincter defects in women with obstetric analsphincter injuries and/or postpartum symptoms of faecal incontinence.MATERIALS AND METHODS: One hundred and sixty-five women were recruited, fourwomen were excluded as they were seen years after their last delivery. TPU and EVU, followedby endonanal ultrasound (EAU), were performed using the B&K Viking 2400 scanner. Sensitivityand specificity, as well as predictive values with 95% confidence intervals, for detectinganal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard.RESULTS: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAScombined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%)for TPU. The sensitivity and specificity for the detection of any defect was 48% (30e67%) and85% (77e91%) for EVU and 64% (44e81%) and 85% (77e91%) for TPU, respectively.CONCLUSION: Although EAU using a rotating endoprobe is the validated reference standardin the identification of anal sphincter defects, it is not universally available. However while TPUand/or EVU with conventional ultrasound probes can be useful in identifying normality, forclinical purposes they are not sensitive enough to identify an underlying sphincter defect.
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