4 Comparing anorectal function tests 103 patients. DRE of the pelvic floor physical therapist was similar to 3D-HRAM in 26 (53%) and 32 (65%) patients in the assessment of the resting and squeeze tone and pressure respectively. Digital rectal examination by the surgeon and pelvic floor physical therapist and surface electromyography (n=49 and n=50) The resting tone assessed by the surgeon’s DRE and s-EMG activity was similar in only 18 (36%) patients. For squeeze this was 32 (65%). DRE by the pelvic floor physical therapist correlated in 18 (36%) and 41 (82%) patients with s-EMG in the assessment of resting tone and squeeze tone. The surgeon and the pelvic floor physical therapist both classified the resting tone with DRE in respectively three and four patients as ‘low’ while s-EMG activity assessed ‘high’. One patient with a chronic anal fissure was classified ‘high’ for squeeze tone with DRE by both the surgeon and pelvic floor physical therapist but classified ‘low’ with s-EMG. Anorectal manometry and surface electromyography (n=49) When the results are categorized as low, normal, and high, the 3D-HRAM and s-EMG correlated well in only 18 (37%) patients when comparing the resting pressure and electric activity. With 29 (59%) patients this was better when comparing the squeeze tone and electric activity. Overall, four patients who were classified as ‘low’ on the 3D-HRAM were classified ‘high’ with s-EMG activity concerning resting pressure and one patient vice versa during squeeze pressure. Comparing detecting dyssynergia Balloonexpulsion test and evacuation of gel during TPUS (n=19) Four patients were not able to evacuate the gel despite being able to expel the balloon within one minute. Three patients evacuated the gel – of whom two not completely – while they were not able to expel the balloon within one minute (Table 3). Table 3. Balloon expulsion test (BET) versus evacuation of gel during transperineal ultrasound Evacuation of gel during TPUS Yes No Total BET <1 minute 5 4 9 >1 minute 3 7 10 Total 8 11 19
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