Angelo Stuto

Purpose: Dynamic magnetic resonance defecography (MRD) is a key imaging modality for comprehensive evaluation of pelvic floor dysfunction, enabling detailed multiplanar anatomical and functional assessment without ionizing radiation. However, despite its established clinical role, MRD reporting is heterogeneous among centers, hindering standardized interpretation, multidisciplinary communication, and comparison across studies. This modified Delphi consensus study aimed to develop a standardized referral dataset and structured reporting framework for MRD. Methods: A multidisciplinary panel of 20 Italian experts (radiologists, colorectal surgeons, gynecologists, urologists, gastroenterologists, physiatrists, and a methodologist) conducted a three-round Delphi process to develop consensus-based templates for MRD referral and reporting. Consensus was set at ≥75% agreement. A total of 36 items were evaluated, covering technical parameters, anatomical/functional findings, and reporting format. Results: Consensus was achieved for 21 items (58%), including technical parameters, standardized measurements (anorectal angle, pubococcygeal line), and clinically relevant descriptors (prolapse, dyssynergia, rectocele, rectal inertia). A structured referral template was also developed to improve information transfer from clinicians to radiologists. Both tools were unanimously endorsed. Conclusions: This modified Delphi consensus study provides a multidisciplinary framework for standardized MRD referral and reporting. The proposed reporting template may facilitate greater consistency in image interpretation, reporting terminology, and multidisciplinary communication. These recommendations may serve as a foundation for the harmonization of MRD practice and future validation studies in pelvic floor imaging.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) on the diagnosis and management of obstructed defecation syndrome (ODS), with the purpose of guiding physicians in the selection of the most appropriate treatment option. A panel of experts was appointed by the Board of the SIUCP to develop key questions addressing the main topics related to the management of ODS and to perform an accurate literature search for each topic, in order to provide evidence-based answers and to summarize them in structured statements. All clinical questions were discussed by the expert panel over multiple rounds using the Delphi approach, and consensus among the experts was achieved for each statement. The questions were formulated according to PICO (patients, intervention, comparison, outcome) criteria, and the statements were developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In patients with ODS refractory to first-line medical therapy, rehabilitation may be considered as a therapeutic option, particularly in cases of dyssynergic defecation, whereas a surgical approach may be indicated in patients with a high symptom score and an Oxford prolapse grade system score ≥3 on defecography (using magnetic resonance imaging or another modality). Surgical options include stapled transanal rectal resection and ventral mesh rectopexy, eventually combined, respectively, with pelvic organ prolapse suspension and sacrocolpopexy in the presence of multicompartment pelvic prolapse. A transverse perineal support procedure may be considered in the presence of excessive perineal descent. In patients with recurrent symptoms after surgery, transanal irrigation may represent a useful therapeutic option.