Manometry Catheters

Water-Perfused Catheters

In principle, smaller catheters are superior to larger ones and flexible are preferred over rigid. The latter have the advantage of easy insertion but are associated with patient discomfort and are often refused. Flexible catheters are more comfortable for the patient but tend to twist in the anal canal. The outside diameter should not

Water Perfused Manometry

Figure 8.4. Water-perfused system (a) with computer screen (b) and polygraph (c).

Figure 8.4. Water-perfused system (a) with computer screen (b) and polygraph (c).

exceed more than 8 mm in order to diminish artifacts.1618 There is a huge array of various types of catheters available, most of which are made of soft plastic. The most commonly used catheters are open-end or side-open catheters, with two to eight lumina (Fig. 8.5). Arrangement of the lumina depends on the operator. Radial catheters are most useful in recording longitudinal pressures in the anal canal. Up to eight channels are used to give a precise pressure description of the different sections of the sphincter muscle during rest, squeeze, or push at a specific height. The catheters are normally marked in 1-cm intervals for vertical orientation (Fig. 8.6). Furthermore, for radial orientation into the anal canal, an additional mark should be made on the catheter. However, assessing sphinc-teric defects with anorectal manometry is limited.19,20 We use a water-perfused system with four radial ports for routine evaluation and eight ports for scientific research studies. While the radial lumina are usually 5 cm apart from the catheters end in adults, the radial ports are more proximal in children. If rectal pressures are measured, an open-end catheter is preferred. Spiral catheters are useful for investigating the rectoanal inhibitory reflex. In this catheter, eight ports are set at 45-degree intervals, 5 to 8 mm apart on the longitudinal axis. A balloon at the very end of the catheter is used for rapid inflation to elicit the reflex. Sleeve catheters are rarely used in anal manometry, as with these catheters only global pressures can be recorded.

Solid-State Catheters

Konigsberg catheters are solid-state/microtip catheters for pressure measurement. They require no water perfusion setup and are therefore easy to use and give reliable, accurate

Figure 8.5. Water-perfused catheter.
Figure 8.6. Water-perfused radial catheters with 1-cm intervals.

results. The catheters are available in a variety of configurations and come with attached probe adapters. The advantage is that these catheters can also be used in the ambulatory setting and allow evaluation in various positions.

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Fire Up Your Core

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