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Cosgriff L, Ramanathan A, Iglesia CB. Pelvic Floor Disorders and Sexual Function: A Review. Obstet Gynecol Clin North Am 2024; 51:241-257. [PMID: 38777481 DOI: 10.1016/j.ogc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Pelvic floor disorders can result in laxity, hypertonicity or spasm, all of which can impact sexual function. It is important for clinicians to understand this impact in order to appropriately counsel and treat their patients.
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Affiliation(s)
- Lauren Cosgriff
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Aparna Ramanathan
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Cheryl B Iglesia
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA.
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Workineh ZA, Ayana BA, Gashaye KT, Wubneh SB, Kassie BA. Surgical management practice of pelvic organ prolapse among Ethiopian gynecologists, 2021: a descriptive study. BMC Womens Health 2023; 23:654. [PMID: 38066529 PMCID: PMC10704734 DOI: 10.1186/s12905-023-02818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Pelvic Organ Prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina. Surgical intervention addresses both anatomical defect and associated symptoms. The landscape of prolapse surgery has been evolving constantly over years. Emerging evidences either support or challenge existing surgical treatment options, making urogynecology a dynamic field. In Ethiopia, the surgical management of pelvic organ prolapse has transitioned from abdominal to vaginal hysterectomy, supplemented later by McCall's culdoplasty. Disparities exist in the national uniformity of surgical approaches, linked to the establishment of Urogynecology centers in certain institutions. OBJECTIVES This study was done to assess the surgical management practice of Ethiopian gynecologists on pelvic organ prolapse. METHODS A cross-sectional study encompassing all Gynecologists in Ethiopia took place between January to June 2021. Information was gathered through online Google forms crafted in English. Subsequently, the collected data underwent verification, coding, and entry into Epi info 7 before being exported to SPSS version 22 software for descriptive statistical analysis. RESULTS We reached 280 gynecologists out of the 450 practicing in the Ethiopia making 62% response rate. Anterior colporrhaphy (98.6%), vaginal hysterectomy with McCall's cul-do-plasty (51.8%), and Posterior colporrhaphy (97.5%) were the most commonly performed surgical procedures for anterior vaginal wall prolapse, apical prolapse (uterine/cervical), and posterior vaginal wall prolapse respectively. Only 3.2% and 0.7% of the gynecologists conducted abdominal and vaginal paravaginal repair for anterior vaginal wall prolapse. Sacrospinous ligament fixation and sacrocolpopexy for apical prolapse were carried out by 32.9% and 9.3% of the gynecologists respectively. Site-specific posterior repair for posterior vaginal wall prolapse was performed only by 23.9% of the gynecologists. The main reasons mentioned not to perform paravaginal repair, sacrocolpopexy, sacrospinous ligament fixation, and site-specific posterior repair were lack of skill and lack of appropriate materials. CONCLUSION AND RECOMMENDATION Most gynecologists in Ethiopian continue to perform vaginal hysterectomy and colporrhaphy procedures for treatment of pelvic organ prolapse due primarily to lack of skill and appropriate materials to perform the alternative procedures. Implementing short term training on alternative surgical treatment options of pelvic organ prolapse with provision of suitable materials and increasing the number of urogynecologists in the country in the long run holds the potential to enhance the standard of care of women with the condition.
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Affiliation(s)
- Zelalem Ayichew Workineh
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Birhanu Abera Ayana
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kiros Terefe Gashaye
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Berhe Wubneh
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Ayanaw Kassie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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BEDEL A, AGOSTINI PA, NETTER DA, PIVANO DA, Caroline DRAMBEAUD, TOURETTE DC. Midline Rectovaginal Fascial Plication: Anatomical and Functional Outcomes at One Year. J Gynecol Obstet Hum Reprod 2022; 51:102327. [DOI: 10.1016/j.jogoh.2022.102327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
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Beckenbodeninsuffizienz und Sexualität aus gynäkologischer Sicht. COLOPROCTOLOGY 2021. [DOI: 10.1007/s00053-021-00552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Laparoscopic versus vaginal native tissue repair in combination with pectopexy. Sub-analysis from an international, prospective, and multi-centre study: short term results. MINIM INVASIV THER 2021; 31:782-788. [PMID: 34278938 DOI: 10.1080/13645706.2021.1941118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of mesh for vaginal repairs is currently problematic and as a consequence, there is increased interest in native tissue repair. We describe the follow-up data of a sub-analysis of a prospective and multi-center study focusing on the combination of pectopexy and native tissue repair. Patients were followed up for 12-18 months after surgery (+ SD: 15). Two-hundred and sixty-four patients attended the clinics for physical examination and were integrated into the follow-up. Cystocele repair was performed laparoscopically in 84 patients and vaginally in 52 patients. Posterior repair was performed vaginally in 40 patients and laparoscopically in 53 patients. Results: Clinical success rate, patient recommendations and patient satisfaction rates were similar in both groups. The laparoscopic anterior repair resulted in an 89% cure or anatomical improvement rate; this compared to 94.2% for the vaginal approach. In the posterior group, laparoscopy resulted in a 94.3% cure or improvement rate compared to 97.5% in the second group. Conclusions: The outcomes of both strategies showed satisfactory results in our study. Consequently, surgeons may choose between the two strategies according to their preference and skill. The two approaches only differed with regard to vaginal scarring. We suggest future research investigating the long-term impact of scarring.
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Kikuchi JY, Muñiz KS, Handa VL. Surgical Repair of the Genital Hiatus: A Narrative Review. Int Urogynecol J 2021; 32:2111-2117. [PMID: 33606054 DOI: 10.1007/s00192-021-04680-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An enlarged genital hiatus (GH) is associated with the development of prolapse and may be associated with prolapse recurrence following surgery; however, there is insufficient evidence to support surgical reduction of the GH as prophylaxis against future prolapse. The objective of this review is (1) to review the association between GH size and pelvic organ prolapse and (2) to discuss the existing literature on surgical procedures that narrow the GH. METHODS A literature search was performed in the PubMed search engine, using the keyword "genital hiatus." Articles were included if they addressed any of the following topics: (1) normative GH values; (2) associations between the GH and prolapse development or recurrence; (3) surgical alteration of the GH; (4) indications, risks or benefits of surgical alteration of the GH. RESULTS An enlarging GH has been observed prior to the development of prolapse. Multiple studies show that an enlarged pre- and/or postoperative GH is associated with an increased risk of recurrent prolapse following prolapse repair surgery. There are limited data on the specific risks of GH alteration related to bowel and sexual function. CONCLUSIONS GH size and prolapse appear to be strongly associated. Because GH size appears to be a risk factor for pelvic organ prolapse, the GH size should be carefully considered at the time of surgery. Surgeons should discuss with their patients the risks and potential benefits of additional procedures designed to reduce GH size.
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Affiliation(s)
- Jacqueline Y Kikuchi
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
| | - Keila S Muñiz
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA
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Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms? Female Pelvic Med Reconstr Surg 2021; 27:18-22. [PMID: 31390332 DOI: 10.1097/spv.0000000000000719] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Our primary objective was to determine the association between rectocele size on defecography and physical examination in symptomatic patients. Our secondary objective was to describe the associations between both defecography and physical examination findings with defecatory symptoms and progression to surgical repair of rectocele. METHODS We performed a retrospective review of all patients referred to a female pelvic medicine and reconstructive surgery clinic with a diagnosis of rectocele based on defecography and/or physical examination at a single institution from 2003 to 2017. Patients who did not have defecatory symptoms, did not undergo defecography imaging, or did not have a physical examination in a female pelvic medicine and reconstructive surgery clinic within 12 months of defecography imaging were excluded. RESULTS Of 200 patients, 181 (90.5%) had a rectocele diagnosed on defecography and 170 (85%) had a rectocele diagnosed on physical examination. Pearson and Spearman tests of correlation both showed a positive relationship between the rectocele size on defecography and rectocele stage on physical examination; however, one was not reliable to predict the results of the other (Pearson correlation = 0.25; Spearman ρ = 0.29). The strongest predictor of surgery was rectocele stage on physical examination (P < 0.001). Size of rectocele on defecography was not a strong independent predictor for surgery (P = 0.01), although its significance improved with the addition of splinting (P = 0.004). CONCLUSIONS Our results suggest that rectocele on defecography does not necessarily equate to rectocele on physical examination in patients with defecatory symptoms. Rectocele on physical examination was more predictive for surgery than rectocele on defecography.
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Derpapas A, Vijaya G, Nikolopoulos K, Nikolopoulos M, Robinson D, Fernando R, Khullar V. The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial. J OBSTET GYNAECOL 2020; 41:594-600. [PMID: 32851902 DOI: 10.1080/01443615.2020.1786805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The most appropriate method for repairing posterior vaginal wall prolapse is still debatable. Women with symptomatic prolapse scheduled to undergo surgical repair in the posterior compartment were randomised to standard posterior colporrhaphy (SPC) or fascial and vaginal epithelial plication (FEP). Participants were assessed with the Prolapse Quality of Life (P-QOL) questionnaire, pelvic organ prolapse quantification (POP-Q) examination and three-dimensional ultrasound (3D US) prior to surgery and 6 months postoperatively. The research hypothesis is that 3D US of the pelvic floor is a reliable tool in comparing the anatomical outcomes of the two different surgical techniques. Differences in anatomical outcomes, assessed clinically and by ultrasonographic evaluation, were compared between the two groups using the Independent Mann-Whitney U-test and the Wilcoxon signed-rank sum test. Twenty-two women were included in the analysis. Six months postoperatively, women in the FEP arm had better anatomical outcomes compared to those who had undergone SPC (p = .02). Repeatability of the ultrasound technique was confirmed, showing moderate to very good agreement in all parameters and the 3D US evaluation was corroborated with the clinical examination, showing a greater reduction in the urogenital size in the FEP group.Impact statementWhat is already known on this subject? The low cost and universal availability of the ultrasound (US) makes it the most commonly used diagnostic modality. The ability to see beyond surface anatomy is important and useful in the assessment of the posterior vaginal wall prolapse and the obstructed defaecation, where this method may replace the defaecation proctography (Dietz 2019). Recent advances in pelvic floor ultrasonography (3D US) have achieved repeatability in the measurement of the levator hiatal (LH) dimensions, introducing a valid and readily available tool for researchers and clinicians (Dietz et al. 2005). Ultrasound may distinguish a true rectocele due to the weakening of the rectovaginal fascia from an enterocele, a rectal intussusception, or just a deficient perineum (Guzman Rojas et al. 2016).What do the results of this study add? Our study demonstrates that 3D translabial pelvic floor ultrasound is a useful and reliable tool in assessing the anatomical outcome of prolapse surgery.What are the implications of these findings for clinical practice and/or further research? Our study demonstrates that 3D translabial ultrasound of the pelvic floor is a useful and reproducible method in evaluating the anatomical outcomes of surgical repair for posterior wall prolapse. Genital hiatus (GH) and levator hiatus (LH) dimensions measured by ultrasound can be used as surrogate anatomical markers in comparing the efficacy of different surgical techniques.
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Affiliation(s)
- Alexandros Derpapas
- Department of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
| | - Gopalan Vijaya
- Department of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
| | - Kostis Nikolopoulos
- Department of Urogynaecology, Epsom and St Helier Hospitals NHS Trust, Surrey, Carshalton, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Ruwan Fernando
- Department of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
| | - Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
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Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol 2020; 17:373-390. [DOI: 10.1038/s41585-020-0334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/09/2022]
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Chang OH, Davidson ERW, Thomas TN, Paraiso MFR, Ferrando CA. Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy? Int Urogynecol J 2020; 31:2075-2080. [DOI: 10.1007/s00192-020-04268-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
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An update of a former
FIGO
Working Group Report on Management of Posterior Compartment Prolapse. Int J Gynaecol Obstet 2019; 148:135-144. [DOI: 10.1002/ijgo.13006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 09/04/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
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Grimes CL, Schimpf MO, Wieslander CK, Sleemi A, Doyle P, Wu YM, Singh R, Balk EM, Rahn DD. Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations. Int Urogynecol J 2019; 30:1433-1454. [PMID: 31256222 DOI: 10.1007/s00192-019-04001-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both conditions among different surgical approaches. METHODS A systematic review was performed comparing the impact of surgical interventions in the posterior compartment on prolapse and defecatory symptoms. MEDLINE, Embase, and ClinicalTrials.gov were searched from inception to 4 April 2018. Randomized controlled trials, prospective and retrospective comparative and single-group studies of women undergoing posterior vaginal compartment surgery for vaginal bulge or bowel symptoms were included. Studies had to include both anatomical and symptom outcomes both pre- and post-surgery. RESULTS Forty-six eligible studies reported on six surgery types. Prolapse and defecatory symptoms improved with native-tissue transvaginal rectocele repair, transanal rectocele repair, and stapled transanal rectocele repair (STARR) surgeries. Although prolapse was improved with sacrocolpoperineopexy, defecatory symptoms worsened. STARR caused high rates of fecal urgency postoperatively, but this symptom typically resolved with time. Site-specific posterior repairs improved prolapse stage and symptoms of obstructed defecation. Compared with the transanal route, native-tissue transvaginal repair resulted in greater improvement in anatomical outcomes, improved obstructed defecation symptoms, and lower chances of rectal injury, but higher rates of dyspareunia. CONCLUSIONS Surgery in the posterior vaginal compartment typically has a high rate of success for anatomical outcomes, obstructed defecation, and bulge symptoms, although these may not persist over time. Based on this evidence, to improve anatomical and symptomatic outcomes, a native-tissue transvaginal rectocele repair should be preferentially performed.
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Affiliation(s)
- Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.
| | - Megan O Schimpf
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Cecilia K Wieslander
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Paula Doyle
- Department of Obstetrics and Gynecology, Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - You Maria Wu
- Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
| | - Ruchira Singh
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Guzman-Negron JM, Fascelli M, Vasavada SP. Posterior Vaginal Wall Prolapse: Suture-Based Repair. Urol Clin North Am 2018; 46:79-85. [PMID: 30466705 DOI: 10.1016/j.ucl.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pelvic organ prolapse is common in parous women, although few report symptoms. The incidence of posterior compartment prolapse, or rectocele, is less well-reported. Posterior vaginal wall prolapse is associated with pain, constipation, and splinting. Surgery is the mainstay of therapy for symptomatic rectoceles. Though several surgical techniques have been described, no clear indications for type of repair have emerged. This article reviews the management strategies and draws conclusions about suture-based and site-specific techniques.
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Affiliation(s)
- Juan M Guzman-Negron
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Michele Fascelli
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sandip P Vasavada
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Transperineal rectocele repair with biomesh: updating of a tertiary refer center prospective study. Int J Colorectal Dis 2018; 33:1583-1588. [PMID: 29675591 DOI: 10.1007/s00384-018-3054-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Symptomatic rectocele results in obstructed defecation and constipation. Surgical repair may provide symptomatic relief. A variety of surgical procedures have been used in the rectocele repair to enhance anatomical and functional results and to improve long-term outcomes. METHODS In this prospective study, we treated 25 selected women suffering from simple symptomatic rectocele with transperineal repair using porcine dermal acellular collagen matrix Biomesh (Permacol®). Watson score and SF-36 questionnaire were used to evaluate postoperative outcomes and quality of life. RESULTS Follow-up ranged from 12 to 24 months, the mean total Watson score was significantly lower than the preoperative score (P < 0.001), and every patient has improved functional outcomes. There were no major intraoperative or postoperative complications. Two cases of urinary infection and 4 patients delayed wound healing were reported. Those patients who were sexually active prior to surgery have not experienced problems with sexual function or dyspareunia. CONCLUSIONS Despite lack of comparative study in literature, rectocele repair with Permacol® by the transperineal approach seems an effective and safe procedure that avoids some of the complications associated with synthetic mesh use.
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Sabooni K, Shahverdi E, Azizi R, Rashidian N, Keramati MR, Pirmohammad H, Konjedi MA, Shahverdi A, Kordehdeh NS. Stapled Trans Anal Rectal Resection and Its Complications in Treatment of Constipation Induced by Rectocele and Rectal Mucosal Prolapse. Indian J Surg 2018. [DOI: 10.1007/s12262-018-1761-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Youssef M, Emile SH, Thabet W, Elfeki HA, Magdy A, Omar W, Khafagy W, Farid M. Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial. J Gastrointest Surg 2017; 21:380-388. [PMID: 27778256 DOI: 10.1007/s11605-016-3299-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/04/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Two types of rectocele exist; type I is characterized by relatively high resting anal pressures, whereas type II has lower resting anal pressures with associated pelvic organ prolapse. We compared trans-perineal repair (TPR) of rectocele with or without limited internal sphincterotomy (LIS) in the treatment of type I anterior rectocele. PATIENTS AND INTERVENTIONS Consecutive patients with anterior rectocele were evaluated for inclusion. Sixty-two female patients with type I anterior rectocele were randomized and equally allocated to receive TPR alone (group I) or TPR with LIS (group II). The primary outcome was the clinical improvement of constipation. Secondary outcomes were recurrence of rectocele, operative time, and postoperative complications including fecal incontinence (FI). RESULTS Clinical improvement of constipation and patients' satisfaction were significantly higher in group II at 1 year of follow-up (93.3 versus 70 %). Constipation scores significantly decreased in both groups postoperatively with more reduction being observed in group II (11.1 ± 2.1 in group I versus 8 ± 1.97 in group II). Significant reduction in the resting anal pressure was noticed in group II. Recurrence was recorded in three (10 %) patients of group I and one patient of group II. No significant differences between the two groups regarding the operative time and hospital stay were noted. CONCLUSION Adding LIS to TPR of type I rectocele achieved better clinical improvement than TPR alone. The only drawback of LIS was the development of a minor degree of FI, which was temporary in duration.
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Affiliation(s)
- Mohamed Youssef
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt.
| | - Waleed Thabet
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
| | - Hossam Ayman Elfeki
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
| | - Alaa Magdy
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
| | - Waleed Omar
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
| | - Wael Khafagy
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
| | - Mohamed Farid
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt
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Rantell A, Srikrishna S, Robinson D. Assessment of the impact of urogenital prolapse on sexual dysfunction. Maturitas 2016; 92:56-60. [PMID: 27621239 DOI: 10.1016/j.maturitas.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
Sexual dysfunction is one of the symptoms that motivates women to seek medical help in the management of urogenital prolapse. Conservative or surgical interventions may be offered to treat the prolapse but the question remains as to whether treatment restores sexual function (SF). This article briefly discusses the assessment of SF in women with a urogenital prolapse and reviews the effect of therapeutic interventions on SF.
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Affiliation(s)
- Angie Rantell
- Department of Urogynaecology, King's College Hospital, London.
| | | | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London
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Thompson JC, Rogers RG. Surgical Management for Pelvic Organ Prolapse and Its Impact on Sexual Function. Sex Med Rev 2016; 4:213-220. [DOI: 10.1016/j.sxmr.2016.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/13/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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Paquette IM, Varma M, Ternent C, Melton-Meaux G, Rafferty JF, Feingold D, Steele SR. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum 2016; 59:479-92. [PMID: 27145304 DOI: 10.1097/dcr.0000000000000599] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Grimes CL, Overholser RH, Xu R, Tan-Kim J, Nager CW, Dyer KY, Menefee SA, Diwadkar GB, Lukacz ES. Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy. Int Urogynecol J 2016; 27:1817-1823. [PMID: 27230408 DOI: 10.1007/s00192-016-3046-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized that there would be a significant difference in changes in obstructed defecation symptoms and posterior compartment prolapse between women who underwent posterior vaginal wall prolapse repair (PR) and those who did not. METHODS This was a two-site prospective cohort study of women undergoing prolapse or incontinence surgery in which a PR was, or was not, performed at the discretion of the surgeon. Women were assessed using validated obstructed defecation questionnaires and standardized examination measures (including POP-Q, measurement of transverse gh, and assessment for a rectovaginal pocket and laxity) prior to pelvic surgery and 12 weeks after surgery. RESULTS Of 68 women who underwent surgery, 43 had PR. The PR group had higher obstructed defecation symptoms and greater posterior compartment prolapse at baseline. At 12 weeks, obstructed defecation symptoms had improved significantly more in the PR group than in the no PR group (all p < 0.03). Anatomic outcomes showed greater improvement in point Bp in the PR group (-3.4 vs. -0.7 no PR, p < 0.001) and resolution of the rectovaginal pocket (86 % vs. 42 %, p = 0.002). There were no significant changes in obstructed defecation symptoms or anatomic outcomes from baseline in the no PR group, while the PR group showed significantly improved obstructed defecation symptoms and anatomic outcomes after repair (p < 0.001 for both). CONCLUSIONS Significant improvements in obstructed defecation symptoms and posterior compartment prolapse were seen after PR, but not in women who did not receive PR. Obstructed defecation symptoms, Bp and rectovaginal pocket were the measures best able to demonstrate improvement after PR. We recommend the use of these measures to assess the impact of surgery in the posterior compartment.
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Affiliation(s)
- Cara L Grimes
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16, Room 127, New York, NY, 10032, USA.
| | - Rosanna H Overholser
- San Diego Clinical and Translational Research Institute, UC San Diego Health System, San Diego, CA, USA
| | - Ronghui Xu
- Department of Family and Preventive Medicine and Department of Mathematics, UC San Diego Health System, San Diego, CA, USA
| | - Jasmine Tan-Kim
- Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA
| | - Charles W Nager
- Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System, La Jolla, CA, USA
| | - Keisha Y Dyer
- Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA
| | - Shawn A Menefee
- Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA
| | - Gouri B Diwadkar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA
| | - Emily S Lukacz
- Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System, La Jolla, CA, USA
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Brown H, Grimes C. Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016; 5:165-171. [PMID: 27547494 DOI: 10.1007/s13669-016-0148-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While it would be our hope to report that there have been significant gains in the understanding of the correlation between the posterior vaginal compartment and defecatory dysfunction in the last year, this is not the case. Instead, we review the highlights of management of posterior vaginal compartment and defecatory dysfunction including 1) defining and understanding the patient's symptoms; 2) considering systemic disorders, motility dysfunction, and mechanical causes that may be contributing; 3) encouraging conservative management as first-line therapy; and 4) recognizing which surgical options are likely to improve specific symptoms. This is then followed by an update on treatment options for fecal incontinence, which we now prefer to refer to as accidental bowel leakage. We are able to report on five exciting and innovative treatment approaches for accidental bowel leakage. As the scientific community increases focus on patient-centered outcomes, we are likely on the verge of having a greater understanding of how treatment options for posterior compartment prolapse and defecatory dysfunction can improve patient symptoms. This year, we can report that strong evidence based recommendations simply do not exist, and this area is ripe for future investigation.
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Affiliation(s)
- Heidi Brown
- University of Wisconsin-Madison School of Medicine & Public Health, Departments of Obstetrics & Gynecology and Urology, Female Pelvic Medicine & Reconstructive Surgery Section, 600 Highland Avenue, Box 6188 (H4/656), Madison, WI 53792, , Fax:
| | - Cara Grimes
- Columbia University Medical Cnter, Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, 622 West 168 Street, PH 16, Room 127, New York, NY 10032, Phone:212-305-0189
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Hale DS, Fenner D. Consistently inconsistent, the posterior vaginal wall. Am J Obstet Gynecol 2016; 214:314-20. [PMID: 26348375 DOI: 10.1016/j.ajog.2015.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/29/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse.
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Affiliation(s)
- Douglass S Hale
- Department of Obstetrics and Gynecology, Indiana University Health Systems, and Division of Female Pelvic Medicine and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN.
| | - Dee Fenner
- Furlong Professor, Department of Women's Health, and Departments of Gynecology, Surgical Services, and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Abstract
Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse.
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Affiliation(s)
- Kyung Hwa Choi
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Yup Hong
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Jamali S, Abedi P, Rasekh A, Mohammadjafari R. The Long Term Effect of Elective Colpoperineoplasty on Sexual Function in the Reproductive Aged Women in Iran. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:912786. [PMID: 27437508 PMCID: PMC4897221 DOI: 10.1155/2014/912786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/12/2014] [Indexed: 11/17/2022]
Abstract
Objective. Many women are suffering from sexual dysfunction followed by vaginal laxity in their reproductive age. The aim of this study was to evaluate the long term effect of colpoperineoplasty on sexual function in Iranian reproductive aged women. Methods. This was a prospective observational study in which 79 women with vaginal laxity who were candidate for selective colpoperineoplasty in Jahrom, Iran, were recruited. Data on sexual function was collected via the Female Sexual Function (FSFI) questionnaire preoperatively, six months and 18 months after colpoperineoplasty. The paired t-test, Wilcoxon, Mann-Whitney, and Repeated Measure test were utilized for statistical purposes. Results. Seventy-six women completed the study by 18 months. The mean FSFI score changed from 24.19 ± 3.09 in baseline to 26.92 ± 3.41 after six months (P < 0.001); however dyspareunia and vaginal dryness were increased significantly. After 18 months all areas of sexual function including pain and lubrication improved significantly compared to the 6th month (P < 0.001). Sexual satisfaction was increased significantly six and 18 months after surgery (P < 0.001), and the total score of sexual function increased to 32.61 ± 1.32 after 18 months (P < 0.001). Conclusion. The long term effect of colpoperineoplasty in women who suffer from vaginal laxity is promising. It seems that patient's dissatisfaction of sexual function can be a basis for colpoperineoplasty.
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Affiliation(s)
- Safieh Jamali
- Department of Midwifery, Nursing & Midwifery School, Jahrom University of Medical Sciences, Jahrom 74179 78681, Iran
| | - Parvin Abedi
- Community Nutrition, Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357 15794, Iran
| | - Athar Rasekh
- OB & GYN Department, Jahrom University of Medical Sciences, Jahrom 74179 78681, Iran
| | - Razieh Mohammadjafari
- OB & GYN Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357 15794, Iran
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Abstract
INTRODUCTION AND HYPOTHESIS The aim was to review the safety and efficacy of surgery for posterior vaginal wall prolapse. METHODS Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. RESULTS Level 1 and 2 evidence suggest that midline plication posterior repair without levatorplasty might have superior objective outcomes compared with site-specific posterior reopair (grade B). Higher dyspareunia rates are reported when levatorplasty is employed (grade C). The transvaginal approach is superior to the transanal approach for repair of posterior wall prolapse (grade A). To date, no studies have shown any benefit of mesh overlay or augmentation of a suture repair for posterior vaginal wall prolapse (grade B). While modified abdominal sacrocolpopexy results have been reported, data on how these results would compare with traditional transvaginal repair of posterior vaginal wall prolapse are lacking. CONCLUSION Midline fascial plication without levatorplasty is the procedure of choice for posterior compartment prolapse. No evidence supports the use of polypropylene mesh or biological graft in posterior vaginal compartment prolapse surgery.
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Posterior repair quantification (PR-Q) using key anatomical indicators (KAI): preliminary report. Int Urogynecol J 2014; 25:1665-72. [DOI: 10.1007/s00192-014-2433-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/03/2014] [Indexed: 12/12/2022]
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Shahghaibi S, Faizi S, Gharibi F. Effect of colporrhaphy on the Sexual Dysfunction of women with pelvic organ prolapsed. Pak J Med Sci 2013; 29:157-60. [PMID: 24353530 PMCID: PMC3809212 DOI: 10.12669/pjms.291.2610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 10/12/2012] [Accepted: 10/16/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of colporrhaphy on sexual problems of women with pelvic organ prolapseis. METHODOLOGY Sixty patients with pelvic organ prolapse (cystocele - rectocele) in a quasi-experimental study before and after treatment were included. Presence of pelvic organ prolapseis was assessed by examination in the lithotomy position. Degree of prolapse was determined according to Pelvic organ Prolapse Quantification (POPQ). Their degree of prolapse was marked from 1 to 3 then was colporrhaphy performed. Follow up of patients for sexual satisfaction was performed three and six months after surgery by telephone and interviews. Data were analyzed by SPSS version 15, the McNamara test, T-test, absolute and relative frequency, mean and standard deviation. RESULTS In sixty (60) women who were studied the mean and standard deviation of pregnancy and delivery rate were 4.4 ±2.2 and 4±2.1 respectively. About 65% of patients were over 35 years of age, 88.3% of women had the history of vaginal delivery and 10% of them had both the history of vaginal delivery and cesarean section. Score of sexual desire abstaining from sex and orgasm due to vaginal bulge before, 3 months and 6 months after colporrhaphy was significant (p=0.0001), but of sexual arousal scores there was no differences between each other. Mean of sexual satisfaction before operation was 30.75±5.70 and three months after operation it was 33.77±4.24 and six months after operation 36.03±3.5 which according to T-Test there was significant (p=0.0001). CONCLUSION Sexual desire, orgasm and sexual satisfaction increased after colporrhaphy, frequency of intercourse and sexual arousal remains unchanged. It appears that colporrhaphy reduce symptoms associated with prolapse which is leading to sexual dissatisfaction and improved sexual satisfaction.
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Affiliation(s)
- Sholeh Shahghaibi
- Sholeh Shahghaibi, Asso. Prof. of Gynecology, Dept. of Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sana Faizi
- Sana Faizi, General Practitioner, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fardin Gharibi
- Fardin Gharibi, MsPH Health Management, Vice Chancellor for Research Affairs, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Wagenlehner FME, Del Amo E, Santoro GA, Petros P. Perineal body repair in patients with third degree rectocele: a critical analysis of the tissue fixation system. Colorectal Dis 2013; 15:e760-5. [PMID: 24118694 DOI: 10.1111/codi.12453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/30/2013] [Indexed: 02/08/2023]
Abstract
AIM We describe the technique of tissue fixation system (TFS) perineal body repair in patients presenting with symptomatic third degree rectocele. METHOD The single sling TFS perineal body repair is performed in three surgical steps: (i) dissection of the rectum off the vagina and laterally displaced perineal body; (ii) identification of the deep transverse perineii muscles beyond their insertion point behind the descending pubic ramus; (iii) elevation and approximation of the separated and laterally displaced perineal bodies by insertion, without tension, of non-stretch 7 mm polypropylene tape into the bodies of the deep transverse perineii muscles. RESULTS From January 2007 to December 2009 we performed the TFS operation for 30 women, median age 61 (range 47-87) years, mean parity 2.6 (range 1-5), with third degree symptomatic low rectocele (median obstructive defaecation syndrome score 19; range 11-24). Median hospital stay was 24 (range 12-96) h. The median visual analogue scale for postoperative pain was 1 (range 1-7). Complications occurred in three cases (10%) and included a surfaced tape that was partly resected (repair maintained), a recurrence of the rectocele due to incorrect placement (failed repair) and a foreign body abscess requiring tape removal. At 12-month follow-up, 27 patients (90%) reported normal defaecation and the median obstructive defaecation syndrome score was significantly reduced to 4 (range 1-6; P < 0.001). CONCLUSION The TFS perineal body repair is an effective, safe, minimally invasive treatment in women with symptomatic low rectocele.
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Affiliation(s)
- F M E Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
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Abedi P, Jamali S, Tadayon M, Parhizkar S, Mogharab F. Effectiveness of selective vaginal tightening on sexual function among reproductive aged women in Iran with vaginal laxity: A quasi-experimental study. J Obstet Gynaecol Res 2013; 40:526-31. [DOI: 10.1111/jog.12195] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/24/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Parvin Abedi
- Department of Midwifery; Menopause and Andropause Research Center; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Kohgiluyeh va Boyer Ahmad Iran
| | - Safieh Jamali
- Department of Midwifery; Nursing and Midwifery School; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Kohgiluyeh va Boyer Ahmad Iran
| | - Mitra Tadayon
- Department of Midwifery; Menopause and Andropause Research Center; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Kohgiluyeh va Boyer Ahmad Iran
| | - Saadat Parhizkar
- Social Determinants of Health Research Center; Yasuj University of Medical Sciences; Yasuj Kohgiluyeh va Boyer Ahmad Iran
| | - Farideh Mogharab
- Department of Obstetrics and Gynecology; Jahrom University of Medical Sciences; Jahrom Iran
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Osborn DJ, Reynolds WS, Dmochowski R. Vaginal approaches to pelvic organ prolapse repair. Curr Opin Urol 2013; 23:299-305. [DOI: 10.1097/mou.0b013e3283619e1a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Murad-Regadas SM, Regadas FSP, Rodrigues LV, Fernandes GODS, Buchen G, Kenmoti VT. Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:135-42. [PMID: 22767001 DOI: 10.1590/s0004-28032012000200008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 12/18/2011] [Indexed: 12/17/2022]
Abstract
CONTEXT Management of patients with obstructed defecation syndrome is still controversial. OBJECTIVE To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. METHODS The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. RESULTS Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. CONCLUSIONS Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts.
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Schmidlin-Enderli K, Schuessler B. A new rectovaginal fascial plication technique for treatment of rectocele with obstructed defecation: a proof of concept study. Int Urogynecol J 2012; 24:613-9. [PMID: 22890282 DOI: 10.1007/s00192-012-1911-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/22/2012] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to investigate the functional and anatomical outcome after a new rectovaginal fascial plication technique in patients with rectoceles or rectal pockets and obstructed defecation. METHODS In a prospective study 54 of 87 patients were examined pre- and postoperatively using the Pelvic Organ Prolapse Quantification (POP-Q) system of the International Continence Society (ICS). Bowel and protrusion symptoms as well as quality of life (QOL) were evaluated by a standardized questionnaire. Surgical therapy consisted of a posterior vaginal wall incision in the midline, a dissection of the vaginal epithelium from the underlying rectovaginal fascia while the rectocele was brought under tension by the index finger in the rectum. Under rectal digital control the surgically exposed rectovaginal fascia was sutured in a cranio-caudal fashion with sagittally positioned running absorbable sutures followed by a careful reapproximation of the laterally separated perineal body in the midline. RESULTS Obstructed defecation symptoms were cured or improved in 72.2 % [95 % confidence interval (CI) 59.1-82.4]. Anatomical cure rate was 92.1 % (95 % CI 79.2-97.3) and protrusion symptoms were resolved in 73.6 % (95 % CI 58.0-85.0). Of the patients who had intercourse, 5.2 % reported de novo dyspareunia postoperatively; in none of these patients was an anatomical cause found. There were no major intra- or postoperative complications. CONCLUSIONS Sagittal rectovaginal fascial plication in symptomatic rectoceles or functionally relevant rectal pockets is associated with a satisfactory anatomical and functional cure rate without impacting sexual function.
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Affiliation(s)
- Karin Schmidlin-Enderli
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
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Gomelsky A, Dmochowski RR. Posterior-compartment repair: a urology perspective. Urol Clin North Am 2012; 39:371-6. [PMID: 22877720 DOI: 10.1016/j.ucl.2012.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The prevalence of posterior-compartment prolapse (rectocele) is not known. The authors have found that operative repair symptomatically improved a majority of patients with impaired defecation associated with a large rectocele, but this improvement was likely related at least in part to factors other than the size of the rectocele. Multiple surgical techniques are available for rectocele repair, and the literature is not clear regarding indications for each type of surgical intervention. This article reviews the literature regarding various types of posterior-compartment repair, and draws conclusions regarding their absolute efficacy and relative efficacy in comparison with one another.
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Affiliation(s)
- Alex Gomelsky
- Department of Urology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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Anterior colporrhaphy versus repair with mesh for anterior vaginal wall prolapse: a comparative clinical study. Arch Gynecol Obstet 2012; 286:965-72. [DOI: 10.1007/s00404-012-2383-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 05/08/2012] [Indexed: 11/25/2022]
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Murad-Regadas SM, Rodrigues LV, Furtado DC, Regadas FSP, Olivia da S. Fernandes G, Regadas Filho FSP, Gondim AC, de Paula Joca da Silva R. The influence of age on posterior pelvic floor dysfunction in women with obstructed defecation syndrome. Tech Coloproctol 2012; 16:227-32. [DOI: 10.1007/s10151-012-0831-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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Effects of transvaginal repair of symptomatic rectocele on symptom-specific distress and impact on quality of life. Int J Gynaecol Obstet 2012; 117:224-7. [DOI: 10.1016/j.ijgo.2012.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/07/2012] [Accepted: 02/22/2012] [Indexed: 11/19/2022]
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Abstract
Obstructed defecation is a common problem that adversely affects the quality of life for many patients. Known causes of obstructed defecation include pelvic dyssynergy, rectocele, rectal intussusception, enterocele, pelvic organ prolapse, and overt rectal prolapse. Management of this condition requires an understanding of urinary, defecatory, and sexual function to achieve an optimal outcome. The goal of surgical treatment is to restore the various pelvic organs to their appropriate anatomic positions. However, there is a poor correlation between anatomic and functional results. As the pelvis contains many structures, a pelvic support or function defect frequently affects other pelvic organs. Optimal outcomes can only be achieved by selecting appropriate treatment modalities that address all of the components of a patient's problem.
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Affiliation(s)
- C. Neal Ellis
- Division of Colorectal Surgery, West Penn Allegheny Health System, Pittsburgh, Pennsylvania.
| | - Rahila Essani
- Division of Colorectal Surgery, West Penn Allegheny Health System, Pittsburgh, Pennsylvania.
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Gorlero F, Glorio M, Lorenzi P, Bruno-Franco M, Mazzei C. New approach in vaginal prolapse repair: mini-invasive surgery associated with application of platelet-rich fibrin. Int Urogynecol J 2012; 23:715-22. [DOI: 10.1007/s00192-012-1667-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 01/06/2012] [Indexed: 10/14/2022]
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Incidence of extrusion following type I polypropylene mesh "kit" repairs in the correction of pelvic organ prolapse. Obstet Gynecol Int 2011; 2012:354897. [PMID: 22190952 PMCID: PMC3236398 DOI: 10.1155/2012/354897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 10/21/2011] [Indexed: 01/11/2023] Open
Abstract
Introduction and Hypothesis. We sought to determine the mesh extrusion (vaginal exposure) rates and subject outcomes following IntePro (Type I polypropylene) mesh “kit” repairs for vaginal prolapse. Methods. Data were pooled from two prospective multicenter studies evaluating the safety and efficacy of the Perigee and Apogee (American Medical Systems, Minnetonka, Minn, USA) to treat anterior and posterior/apical prolapses, respectively. Extrusions involving the anterior compartment (AC) or posterior compartment/apex (PC/A) were recorded. Results. Two hundred sixty women underwent mesh placement, with a total of 368 mesh units inserted (173 in the AC and 195 in the PC/A). Extrusions were noted in 13 (7.5%) of AC implants and 27 (13.8%) of PC/A implants through 12 months. No difference was seen between those with and without extrusion in regard to anatomic cure, postoperative painor quality of life at 1 year. Conclusions. Extrusion had no apparent effect on short-term outcomes. Given the unknown long-term sequellae of vaginal mesh exposure, a thorough assessment of risks and benefits of transvaginal mesh placement should be considered at the time of preoperative planning.
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Grimes CL, Tan-Kim J, Whitcomb EL, Lukacz ES, Menefee SA. Long-term outcomes after native tissue vs. biological graft-augmented repair in the posterior compartment. Int Urogynecol J 2011; 23:597-604. [PMID: 22113260 DOI: 10.1007/s00192-011-1607-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 10/28/2011] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to compare the outcomes of native tissue vs. biological graft-augmented repair in the posterior compartment. We hypothesized that the addition of graft would result in superior anatomic and functional outcomes. METHODS A retrospective review of posterior repairs between 2001 and 2008 was performed to compare the anatomic and functional outcomes between native tissue and graft-augmented techniques. Mann-Whitney and chi-square tests were used. Power calculation determined that 32 subjects were needed in each group. RESULTS One hundred twenty-four native tissue and 69 graft-augmented repairs were performed with a median follow-up of 35.8 months (range, 6 to 157 months). Anatomic success was similar for native tissue vs. graft (Bp < -1, 86% vs. 80% and Bp ≤ 0, 97% vs. 97%; all p > 0.05). Postoperative splinting and incomplete evacuation was greater in the graft group (splinting, 85% vs. 68%; p = 0.04 and incomplete evacuation, 85% vs. 64%; p = 0.03). CONCLUSION Long-term success of posterior repair is high. Graft augmentation does not appear to improve anatomic or functional outcomes.
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Affiliation(s)
- Cara L Grimes
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Reproductive Medicine, University of California-San Diego, La Jolla, CA, USA.
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Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology. Maturitas 2011; 70:210-5. [PMID: 21943557 DOI: 10.1016/j.maturitas.2011.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/16/2011] [Indexed: 11/23/2022]
Abstract
SEXUAL FUNCTION IN AGING WOMEN: Sexuality is an integral part of human expressions. Mental health plays a major role in sexuality. Several psychological interventions are proposed to increase the sexual quality of life in older women with diverse gynecologic pathology. A biopsychosocial approach utilizing brief strategies can be easily implemented in clinics to help women of all ages increase their sexual quality of life. THE IMPACT OF FEMALE PELVIC FLOOR DISORDERS ON SEXUAL FUNCTION IN OLDER WOMEN: Female pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence. These disorders increase dramatically with increasing age. Urinary incontinence has been demonstrated to have a negative impact on a woman's sexual function. Among sexually active older women with urinary incontinence, 22% report being moderately or extremely worried that sexual activity would cause urine loss. An increased prevalence of sexual distress [9% (6/76) vs. 1.3% (2/216), p=0.005] has been reported in sexually active women over 40 years old with urinary incontinence. Treatment of urinary incontinence can improve sexual function in older women. Among sexually active women (N=53) who underwent midurethral slings procedures for the correction of urinary incontinence, increased coital frequency, decrease fear of incontinence with coitus, decreased embarrassment due to incontinence was reported six months after surgery. Pelvic organ prolapse, a hernia of the vagina resulting in a visible vaginal bulge, has also been associated with a negative impact on sexual function. Women with advanced pelvic organ prolapse (POP-Q stage III or IV) have been demonstrated to have decreased body image reporting that they are more self-conscious about their appearance [adjusted odds ratio (AOR) 4.7; 95% confidence interval (CI) 2.9, 51], feel less feminine (AOR 4.0; 95% CI 1.2, 15) and less sexually attractive (AOR 4.6; 95% CI 1.4, 17) compared with women who have normal pelvic support. Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse have been demonstrated to improve sexual function. MENTAL HEALTH: Mental health plays a major role in older woman's sexuality. Sexual interest and satisfaction is tied to emotional expressivity, women's self-worth, feelings of depression and loneliness as well as cognitive function. Research has shown that both general practitioners and specialists lack training in sexual assessments. Behavioral health specialists, such as a psychologist, can play an integral role in helping to facilitate communication between the patient and the provider. A main focus of communication training is to facilitate open and genuine conversation between the provider and the patient. Providers are encouraged to ask open ended questions while patients are encouraged to discuss symptoms while coping with an internal state of anxiety. Despite the known prevalence of sexual dysfunction among older women, few studied empirically based interventions have been published with these women. This speaks to the general assumption among medical professionals that having the "sex talk" in older women with gynecological pathology is not important or relevant. A biopsychosocial approach utilizing some of the aforementioned brief strategies can be easily implemented in comprehensive gynecology clinics in order to help women of all ages increase their sexual quality of life.
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Wehbe SA, Kellogg S, Whitmore K. Urogenital complaints and female sexual dysfunction. Part 2. J Sex Med 2011; 7:2304-17; quiz 2318-9. [PMID: 20653832 DOI: 10.1111/j.1743-6109.2010.01951.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity. AIM Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function. METHODS Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia. MAIN OUTCOME MEASURES Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function. RESULTS FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function. CONCLUSIONS Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.
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Affiliation(s)
- Salim A Wehbe
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Zbar AP. How clinically important is ultrasonographic definition of the rectogenital septum in surgical decision-making? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:255-256. [PMID: 21337652 DOI: 10.1002/uog.8938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- A P Zbar
- Department of Surgery and Transplantation, Chaim-Sheba Medical Centre, Tel-Hashomer Hospital, Tel-Aviv, Israel.
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Reid RI. Repair of recurrent prolapse. Best Pract Res Clin Obstet Gynaecol 2011; 25:175-96. [PMID: 21353645 DOI: 10.1016/j.bpobgyn.2010.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/23/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
Abstract
The pathogenesis of prolapse and the requirements for a successful surgical outcome vary from one person to another. The importance of traditional risk factors is questionable, but failed previous repair is definitely an adverse prognosticator. An ideal operation should re-attach apical support to the pelvic skeleton, restore integrity within anterior and posterior suspensory hammocks and re-distribute some of the expulsive load back onto the pelvic diaphragm. Reasons for failure are best analysed by location; recurrence within the operated compartment should also be distinguished from recurrence in a different compartment. There is no all-encompassing secret to re-operating on recurrent prolapse. Success depends on sound strategic planning and using tactics to negate the greater technical difficulty and reduced collagen strength in women with prior operative failure. If an augmented repair is to be carried out, choice of biomaterials must reflect surgical objectives, movement dynamics and functional anatomy at the intended implantation site.
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Affiliation(s)
- Richard I Reid
- Specialist Medical Centre, Suite 4, 235 New South Head Road, Edgecliff NSW 2027, Australia.
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