Electromanometry has been used to determine the degree of incontinence since the early 1960s [11-13]. Holschneider  electromanometrically defined four grades of continence. These grades were derived from numerous parameters, such as anorectal pressure profile, fluctuations, relaxation of the internal sphincter, external sphincter contractions, puborectalis sphinc-
1. Voluntary bowel movements
Feeling of urge Capacity to verbalize Hold the bowel movement
Grade 1 Occasionally (once or twice per week)
Grade 2 Every day, no social problem
Grade 3 Constant, social problem
Grade 1 Manageable by changes in diet Grade 2 Requires laxatives Grade 3 Requires enemas
Grade 1 Mild dribbling/wetness day and night Grade 2 Complete incontinence ter contractions, pressure tolerance, defecation reflex, adaptation, compliance, and critical volume. The criteria for grading continence were well established, but there remained some inconsistency due to overlapping of the parameters in the different groups. The author stated that electromanometric scoring reveals more unfavorable results when compared to clinical scores, but data derived from a large series of patients undergoing both clinical and electromanometric scoring are lacking. However, he suggested including selected manometric data in his clinical score for obtaining a more objective result .
Diseth and Emblem  confirmed that anal canal resting pressure and squeeze pressure correlated negatively with fecal incontinence. In a study of Hed-lund et al. , abnormal anal resting tone was found in 14 out of 17 patients with soiling 5-10 years after repair. However, the correlation to clinical results was incomplete and some patients without soiling had an abnormal resting tone. Other authors confirmed a lack of correlation of some manometric parameters with clinical continence. In a long-term study of 22 patients with high ARM, Rintala et al.  found that the only manometric parameter that correlated with the continence outcome was voluntary squeeze pressure.
Schuster et al.  recently used computerized vector manometry in 17 patients with various types of ARM. Besides computerized software supported by data on standard manometric parameters, a score assessing three pressure zones of the anal canal (0-16 points) was established. However, the authors found a poor correlation between quantitative manometric parameters and clinical results, which were assessed by a modified Kelly score.
Fukata et al.  compared endosonography and electromyography of the external anal sphincter with electromanometry and clinical data derived from the Kelly score. Endosonographic findings for the external anal sphincter corresponded well with elec-tromyographic findings, but not with manometry. Only 15 patients were investigated. Jones et al.  compared endosonography with magnetic resonance imaging after repair of ARM. The findings were comparable in only 9 out of 14 patients. Fukuya et al.  compared magnetic resonance imaging with clinical assessment on the basis of the Kelly score. The proportion of "fair" or "poor" developed muscles was not significantly different between the continence groups according to Kelly. Therefore, no conclusion concerning the correlation of endosonographic and magnetic resonance imaging findings with clinical scores can be drawn to date.
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