Role of Magnetic Resonance Defecography in Assessment of Obstructed Defecation Syndrome in Adult Male Patient

Background: Dynamic magnetic resonance defecography (MRD) is a safe noninvasive modality for the diagnosis, stratification, therapy-guidance of cases with obstructed defecation syndrome (ODS). The MRD emerged as a valuable method in evaluating pelvic floor disorders. Aim:  This study aimed to evaluate the effectiveness of dynamic magnetic resonance defecography in identifying pelvic floor dysfunction in adult male cases with obstructed defecation syndrome, assessing its correlation with clinical severity scores. Methods: This prospective research has been performed on Thirty-five patients with obstructed defecation syndrome who were referred from Mansoura University Outpatient General Surgery Clinics for imaging centers using MRI devices over a period of one year from November 2022 till November 2023.
Results: All patients were adult males (mean age 39.5 ± 14.1 years). Median Cleveland Clinic Constipation Score (CCCS) and Altomare Obstructed Defecation Syndrome (ODS) score were 14.5 (12–20) and 18 (14–27), respectively. Mean ARA was 110.9 ± 11 at rest, 94.8 ± 12.7 at squeeze, and 108.2 ± 14.4 at defecation. Mean H-line increased from 4.1 ± 0.6 cm at rest to 5.3 ± 1.5 cm at defecation, and mean M-line from 1.1 ± 0.7 cm to 3.2 ± 1.9 cm. Pelvic descent occurred in 65%, anterior rectocele in 30%, rectal intussusception in 5%, and anismus in 45%. Both scores correlated negatively with ARA change and positively with H-line and M-line changes, with strong positive correlations for M-line.
Conclusion: Dynamic pelvic MR defecography is a reliable tool for assessing pelvic floor function, as it lacks ionizing radiation and provides good contrast, with a strong correlation between M-line changes.