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  1. Anal sphincter trauma and anal incontinence in urogynecological patients
    Guzmán Rojas RA, Kamisan Atan I, Shek KL, Dietz HP
    Ultrasound Obstet Gynecol, 2015 Sep;46(3):363-6.
    PMID: 25766889 DOI: 10.1002/uog.14845
    To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma.
  2. Defect-specific rectocele repair: medium-term anatomical, functional and subjective outcomes
    Guzmán Rojas R, Kamisan Atan I, Shek KL, Dietz HP
    Aust N Z J Obstet Gynaecol, 2015 Oct;55(5):487-92.
    PMID: 26172410 DOI: 10.1111/ajo.12347
    Rectocele is a herniation of the anterior wall of the rectal ampulla through a defect in the rectovaginal septum causing protrusion of the posterior vaginal wall. Common symptoms include symptoms of prolapse and obstructed defecation.
  3. Digitation associated with defecation: what does it mean in urogynaecological patients?
    Hai-Ying C, Guzmán Rojas R, Hall JC, Atan IK, Dietz HP
    Int Urogynecol J, 2016 Feb;27(2):229-32.
    PMID: 26264476 DOI: 10.1007/s00192-015-2813-7
    INTRODUCTION AND HYPOTHESIS: Obstructed defecation is a common symptom complex in urogynaecological patients, and perineal, vaginal and/or anal digitation may required for defecation. Translabial ultrasound can be used to assess anorectal anatomy, similar to defecation proctography. The aim of the present study was to determine the association between different forms of digitation (vaginal, perineal and anal) and abnormal posterior compartment anatomy.

    METHODS: A total of 271 patients were analysed in a retrospective study utilising archived ultrasound volume datasets. Symptoms of obstructed defecation (straining at stool, incomplete bowel emptying, perineal, vaginal and anal digitation) were ascertained on interview. Postprocessing of stored 3D/4D translabial ultrasound datasets obtained on maximal Valsalva was used to diagnose descent of the rectal ampulla, rectocoele, enterocoele and rectal intussusception at a later date, blinded to all clinical data.

    RESULTS: Digitation was reported by 39 % of our population. The position of the rectal ampulla on Valsalva was associated with perineal (p = 0.02) and vaginal (p = 0.02) digitation. The presence of a true rectocoele was significantly associated with perineal (p = 0.04) and anal (p = 0.03) digitation. Rectocoele depth was associated with all three forms of digitation (P = 0.005-0.02). The bother of symptoms of obstructed defecation was strongly associated with digitation (all P 

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