{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:10:16Z","timestamp":1779095416326,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the prevalence of major perineal trauma in a urogynecological population, to test the predictive value of sonographic tear grading (Gillor algorithm) for anal incontinence (AI), AI bother score and St Mark's score, and to compare the predictive power of the Gillor algorithm with that of the residual\u2010defect method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective study of 721 women attending a tertiary urogynecology unit between February 2019 and May 2021. All women underwent a standardized interview, including determination of St Mark's score and visual analog scale (VAS) bother score for AI, as well as exoanal (translabial) ultrasound with later offline analysis. Results were reported as the presence of a residual defect of the external anal sphincter (EAS), i.e. a discontinuity of \u2265\u200930\u00b0 in \u2265\u20094\/6 tomographic slices, and according to the Gillor algorithm (normal, Grade 3a, Grade 3b or Grade 3c\/4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age at assessment was 57 (range, 19\u201393) years and mean body mass index was 30 (range, 17\u201357) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Six hundred and thirty\u2010six (88.2%) women were vaginally parous and 161 (22.3%) had undergone at least one forceps delivery. AI was reported by 186\/721 (25.8%) women, with a median St Mark's score of 10 (interquartile range (IQR), 6\u201314) and a median VAS score of 6.3 (IQR, 3.9\u201310). EAS defects were detected in 261 (36.2%) women, with a residual defect diagnosed in 88 (12.2%). On sonographic grading according to the Gillor algorithm, we identified 532 (73.8%) women with a normal sphincter, 66 (9.2%) with Grade\u20103a tear, 87 (12.1%) with Grade\u20103b tear and 36 (5.0%) with Grade\u20103c\/4 tear. In total, the Gillor algorithm classified 189 (26.2%) women as having suffered a major perineal tear. The two grading systems were in moderate agreement (\u03ba, 0.537 (95%\u2009CI, 0.49\u20130.56);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). There were weak, albeit significant, associations between EAS defects and measures of AI (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009 to\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.047), both for residual defect as well as the Gillor algorithm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Neither the Gillor algorithm nor the residual\u2010defect method of quantifying sphincter trauma on imaging is clearly superior in terms of predicting AI. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.26052","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T17:22:35Z","timestamp":1660756955000},"page":"800-804","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Validation of new ultrasound algorithm for estimating prevalence of anal sphincter trauma in a urogynecological population"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2211-6149","authenticated-orcid":false,"given":"H. P.","family":"Dietz","sequence":"first","affiliation":[{"name":"Sydney Urodynamic Centres  Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6836-4474","authenticated-orcid":false,"given":"K. L.","family":"Shek","sequence":"additional","affiliation":[{"name":"Western Sydney University  Liverpool NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. K.","family":"Low","sequence":"additional","affiliation":[{"name":"Research Operations, Nepean Hospital, Nepean Blue Mountain Local Health District  Kingswood NSW Australia"},{"name":"Professorial Unit, The George Institute for Global Health University of New South Wales  Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2006.00644.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.06.048"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00799.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13368"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6933.887"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001297"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1994.tb13005.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7512"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.14767"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20175"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04122-5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e318251dca1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40477-020-00485-4"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.14246"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22011"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17306"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04033-5"},{"key":"e_1_2_7_19_1","first-page":"S40","article-title":"Confounders of the relationship between anal sphincter trauma and anal incontinence","volume":"33","author":"Dietz H","year":"2021","journal-title":"Int Urogynecol J"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-015-1397-z"},{"key":"e_1_2_7_21_1","first-page":"S118","article-title":"The \u2018Fascial Plane\u2019 seen on tomographic exo\u2010anal imaging of the anal canal: a diagnostic quandary?","volume":"33","author":"Dietz H","year":"2021","journal-title":"Int Urogynecol J"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4373"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14845"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18827"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24504"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-03954-5"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.04.009"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13701"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3391-7"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20124"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12592"}],"container-title":["Ultrasound in Obstetrics &amp; 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