4 Comparing anorectal function tests 97 The Proctos Clinic is a tertiary referral center for specialized proctological care with experienced surgeons, a pelvic floor physical therapist and a fully equipped anorectal function laboratory. The aim of our study was to examine the correlation of the anal pressures between DRE, 3D-HRAM and the s-EMG. DRE, 3D-HRAM, s-EMG, BET and the trans-perineal ultrasound were compared to diagnose dyssynergia. Furthermore, we sought to assess the level of agreement between DRE performed by the surgeon and the pelvic floor physical therapist. Material and Methods Study population The Proctos Clinic is a tertiary referral center for anorectal function complaints. Between January 2020 and April 2022, men and women aged 18 to 80 years, who underwent anorectal function tests and were referred for pelvic floor physical therapy (PFPT), were invited to participate in the study. Exclusion criteria were noncompliance with verbal instruction in Dutch and current psychiatric disorders. Patients in whom the timeframe was more than 4 weeks between the tests were excluded as the measurements may not be comparable. Patients first visited the surgeon, who performed a DRE and a transperineal ultrasound and counseled the patients for the study. Subsequently, patients were asked to participate in case they were referred for 3D-HRAM, BET and pelvic floor physical therapy. The pelvic floor physical therapist also performed DRE and s-EMG at first visit. The pelvic floor physical therapist was blinded for the DRE of the surgeon and also for the results of de 3D-HRAM, BET and transperineal ultrasound. All appointments were scheduled within 4 weeks. Results of the different tests were prospectively recorded. All patients signed a written informed consent before entering the study. The study was approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centres, location AMC. Anorectal investigations Digital rectal examination DRE was performed by all five surgeons and the pelvic floor physical therapist in the same standardized way. The procedure of DRE was explained to the patient. During the assessment the patient was lying on his/her left side with the knees flexed at 90.0. The examiners used non-allergic gloves lubricated with water-based gel. All patients
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