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Pizzoferrato AC, Sallée C, Thubert T, Fauconnier A, Deffieux X. Value of pelvic examination in women with pelvic organ prolapse: A systematic review. Int J Gynaecol Obstet 2024. [PMID: 38778697 DOI: 10.1002/ijgo.15697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination. OBJECTIVES The aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse-associated symptoms in terms of diagnosis and predictability of treatment success. SEARCH STRATEGY The databases were queried similarly using Medical Subject Headings (MeSH) and non-MeSH terms broadly related to pelvic examination and POP management. SELECTION CRITERIA We included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery. DATA COLLECTION AND ANALYSIS We assessed peer-reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS-E or RoB2 tools. MAIN RESULTS In all, 67 studies were retained for the review. Prolapse-associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements. CONCLUSIONS In women complaining of prolapse-associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion-discernible on pelvic examination-are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, CHU de Poitiers, Poitiers, France
- Université de Poitiers, CIC-Inserm, DECLAN, Poitiers, France
| | - Camille Sallée
- Department of Obstetrics and Gynecology, Limoges University Hospital, Limoges, France
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Intercommunal Hospital Center of Poissy Saint-Germain-en-Laye, Poissy, France
- Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Xavier Deffieux
- Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France
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Martoccia A, Al Salhi Y, Fuschi A, Rera OA, Suraci PP, Scalzo S, Antonioni A, Valenzi FM, Sequi MB, De Nunzio C, Lombardo R, Sciarra A, Di Pierro G, Bozzini G, Asimakopoulos AD, Finazzi Agrò E, Zucchi A, Gubiotti M, Cervigni M, Carbone A, Pastore AL. Robot-Assisted Sacrocolpopexy versus Trans-Vaginal Multicompartment Prolapse Repair: Impact on Lower Bowel Tract Function. Biomedicines 2023; 11:2105. [PMID: 37626605 PMCID: PMC10452351 DOI: 10.3390/biomedicines11082105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study evaluated the effectiveness, safety, and possible changes in bowel symptoms after multicompartment prolapse surgery by comparing two different surgical approaches, transvaginal mesh surgery with levatorplasty (TVMLP) and robot-assisted sacrocolpopexy (RSC). METHODS All patients underwent pelvic (POP-Q staging system) and rectal examination to evaluate anal sphincter tone in the lithotomy position with the appropriate Valsalva test. The preoperative evaluation included urodynamics and pelvic magnetic resonance defecography. Patient Global Impression of Improvement (PGI-I) at follow-up measured subjective improvement. All patients completed Agachan-Wexner's questionnaire at 0 and 12 months of follow-up to evaluate bowel symptoms. RESULTS A total of 73 cases were randomized into the RSC group (36 cases) and TVMLP group (37 cases). After surgery, the main POP-Q stage in both groups was stage I (RCS 80.5% vs. TVMLP 82%). There was a significant difference (p < 0.05) in postoperative anal sphincter tone: 35%. The TVMLP group experienced a hypertonic anal sphincter, while none of the RSC group did. Regarding subjective improvement, the median PGI-I was 1 in both groups. At 12 months of follow-up, both groups exhibited a significant improvement in bowel symptoms. CONCLUSIONS RSC and TVMLP successfully corrected multicompartment POP. RSC showed a greater improvement in the total Agachan-Wexner score and lower bowel symptoms.
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Affiliation(s)
- Alessia Martoccia
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Yazan Al Salhi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Andrea Fuschi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Silvio Scalzo
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Alice Antonioni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Alessandro Sciarra
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giovanni Di Pierro
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant’Anna Hospital, 22100 Como, Italy;
| | - Anastasios D. Asimakopoulos
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | - Enrico Finazzi Agrò
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | | | | | - Mauro Cervigni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Carbone
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
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Abstract
Normal defecation is a complex and coordinated physiologic process that involves the rectum, anus, anal sphincter complex, and pelvic floor muscles. Any alteration of this process can be considered defecatory dysfunction, a term that covers a broad range of disorders, including slow-transit constipation, functional constipation, and functional or anatomic outlet obstruction. Evaluation should include history, physical, and consideration of additional testing such as colonoscopy, colonic transit studies, defecography, and/or anorectal manometry. Depending on the etiology, management options can include conservative measures such as dietary or lifestyle modifications, medications, pelvic floor physical therapy, or surgical repair.
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Karjalainen PK, Mattsson NK, Nieminen K, Tolppanen AM, Jalkanen JT. The relationship of defecation symptoms and posterior vaginal wall prolapse in women undergoing pelvic organ prolapse surgery. Am J Obstet Gynecol 2019; 221:480.e1-480.e10. [PMID: 31128111 DOI: 10.1016/j.ajog.2019.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/30/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Defecation symptoms are common among women with pelvic organ prolapse. However, the relationship between posterior vaginal wall prolapse and defecation symptoms remains debatable. Even though there is a plausible biomechanical rationale for posterior wall prolapse to cause obstructed defecation, previous studies have drawn contradictory conclusions regarding the association. OBJECTIVE We aimed to examine the association between posterior vaginal wall prolapse and defecation symptoms by assessing the following: (1) does prevalence of defecation symptoms increase along with posterior wall prolapse severity, (2) is postoperative symptom improvement greater in women who underwent posterior compartment procedures in comparison with those who did not, and (3) is symptom improvement related to the symptom's correlation with the degree of prolapse? STUDY DESIGN We used data from a nationwide longitudinal cohort study with 3515 women undergoing pelvic organ prolapse surgery. We measured the prevalence of 9 defecation symptoms at baseline and at 6 and 24 months after surgery using the short form of the Pelvic Floor Distress Inventory. Baseline degree of prolapse was categorized in stages as defined by the Pelvic Organ Prolapse Quantification System. The relationship between the degree of posterior wall prolapse and prevalence of bothersome defecation symptoms was studied with logistic regression and adjusted for patient characteristics and severity of anterior wall and apical prolapse. Generalized estimating equations were used to assess the longitudinal change in symptom prevalence in groups of participants with and without repair for posterior vaginal compartment. Correlations between symptom improvement and symptom dependency on the degree of prolapse was assessed by calculating Pearson's correlation coefficient. RESULTS The stage of posterior wall prolapse (stage 2 vs stage 0) correlated with splinting, straining, incomplete evacuation, fecal incontinence of liquid stool, pain during defecation, fecal urgency, and anorectal prolapse (adjusted odds ratios, 2.7, 2.1, 2.0, 1.5, 2.1, 1.4, and 2.2, respectively; P ≤ .007 for all). Flatal incontinence and fecal incontinence of solid stool were not associated with the severity of posterior vaginal wall prolapse. Obstructed defecation symptoms (splinting, straining, and incomplete evacuation) improved more in women undergoing posterior compartment surgery compared with women undergoing repair for other compartments. The greatest improvement at follow-up was observed for those symptoms that showed strongest association with the degree of prolapse at baseline. CONCLUSION Obstructed defecation symptoms are dependent on the posterior wall anatomy. Women presenting with posterior wall prolapse, and these symptoms can expect to improve after surgery. Other defecation symptoms also improve after pelvic organ prolapse surgery, but they are not as specific to posterior wall anatomy as obstructed defecation symptoms.
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American Urogynecologic Society Best-Practice Statement on Evaluation of Obstructed Defecation. Female Pelvic Med Reconstr Surg 2019; 24:383-391. [PMID: 30365459 DOI: 10.1097/spv.0000000000000635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The symptoms of constipation and obstructed defecation are common in women with pelvic floor disorders. Female pelvic medicine and reconstructive surgery specialists evaluate and treat women with these symptoms, with the initial consultation often occurring when a woman has the symptom or sign of posterior compartment pelvic organ prolapse (including rectocele or enterocele) or if a rectocele or enterocele is identified in pelvic imaging. This best-practice statement will review techniques used to evaluate constipation and obstructed defecation, with a special focus on the relationship between obstructed defecation, constipation, and pelvic organ prolapse.
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Abstract
PURPOSE OF REVIEW To summarize the current recommendations for the evaluation and management of defecatory dysfunction in women and highlight key relationships between defecatory dysfunction and other pelvic floor disorders, including pelvic organ prolapse, fecal incontinence, and voiding dysfunction. RECENT FINDINGS Conservative measures including lifestyle modifications, pharmacotherapy, and biofeedback continue to be the mainstay of treatment with newer therapies emerging. Physiologic testing and/or radiologic imaging should be considered for those who fail conservative therapy or are clinically complex. Surgical management is appropriate for carefully selected patients with anatomic causes of defecatory dysfunction. Further research is needed on surgical outcomes and patient expectations. SUMMARY Pelvic floor disorders, including defecatory dysfunction, have a significant societal impact and are highly prevalent among women. Given its potential complexity, a broader focus is needed when evaluating women with defecatory symptoms and effective treatment may require multidisciplinary care.
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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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Abstract
OBJECTIVES The literature states that patients with pelvic organ prolapse have a higher prevalence of bothersome bowel symptoms and that surgical correction of prolapse may improve bowel function. There is limited knowledge regarding the impact of pessary use on bowel function in patients with prolapse. The aim of this study was to evaluate if there is a change in bowel symptoms in patients with prolapse treated with a vaginal pessary. METHODS Women who presented for pessary insertion completed the validated questionnaires on the bowel symptom severity and on the effect of bowel symptoms on the quality of life at baseline and again at 12 months of continuous pessary use. Inferential statistics comprised Student t test for evaluating differences in continuous Gaussian data between groups and paired t tests were used to evaluate differences among subjects between the baseline and 12 months of use. RESULTS One hundred four women participated in the original study, and 43 had complete data for analysis. Women who completed 12 months of pessary use reported significant improvements in both bowel-related symptoms and bowel-related quality of life (95% confidence interval of the difference 1.6-11.4 and 2.0-14.0, respectively). Patients who completed the 12-month follow-up were significantly older and more likely to have stage 3 or 4 prolapse than noncompleters, but there were no differences in body mass index, race, history of prior prolapse surgery, or menopause status. CONCLUSIONS In women with prolapse, the use of a pessary is associated with a decrease in complaints related to bowel symptoms.
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Johnson P, Larson KA, Hsu Y, Fenner DE, Morgan D, Delancey JOL. Self-reported natural history of recurrent prolapse among women presenting to a tertiary care center. Int J Gynaecol Obstet 2012; 120:53-6. [PMID: 23073228 DOI: 10.1016/j.ijgo.2012.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 07/06/2012] [Accepted: 09/25/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the characteristics of recurrent pelvic organ prolapse (POP). METHODS A convenience sample of patients presenting with recurrent POP symptoms between October 2007 and February 2010 completed questionnaires. The survey focused on timing of recurrence(s), symptoms, and demographics. RESULTS Ninety-seven women completed questionnaires. Thirty-four (35.1%) had undergone multiple prior treatments. Overall, 23 of 76 (30.3%) women had not informed their surgeon of the recurrence. Twenty-seven of 59 (45.8%) women reported that their symptoms were the same as before treatment, whereas 23 of 59 (39.0%) reported more severe symptoms. POP was considered to be persistent if symptoms returned within 3 months, and recurrent if symptom relief exceeded 3 months. After primary surgery, 28 of 79 (35.4%) cases were considered to be persistent, whereas 51 (64.6%) cases were recurrent. Similar percentages were seen after second and third treatments. CONCLUSION Overall, 35% of participants experienced early return of symptoms. Almost one-third of participants had not informed their surgeon of the recurrence, indicating that there may not be an accurate self-assessment of outcome in the absence of careful follow-up.
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Affiliation(s)
- Payton Johnson
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
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Grimes CL, Lukacz ES. Posterior vaginal compartment prolapse and defecatory dysfunction: are they related? Int Urogynecol J 2012; 23:537-51. [PMID: 22222672 DOI: 10.1007/s00192-011-1629-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/06/2011] [Indexed: 02/07/2023]
Abstract
While posterior vaginal compartment prolapse and defecatory dysfunction are highly prevalent conditions in women with pelvic floor disorders, the relationship between anatomy and symptoms, specifically obstructed defecation, is incompletely understood. This review discusses the anatomy of the posterior vaginal compartment and definitions of defecatory dysfunction and obstructed defecation. A clinically useful classification system for defecatory dysfunction is highlighted. Available tools for the measurement of symptoms, physical findings, and imaging in women with posterior compartment prolapse are discussed. Based on a critical review of the literature, we investigate and summarize whether posterior compartment anatomy correlates with function. Definitions of obstructed defecation and significant posterior compartment prolapse are proposed for future exploration.
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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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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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Patel M, O’Sullivan DM, LaSala CA. Constipation symptoms before and after vaginal and abdominal pelvic reconstructive surgery. Int Urogynecol J 2011; 22:1413-9. [DOI: 10.1007/s00192-011-1489-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 06/14/2011] [Indexed: 01/14/2023]
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Saks EK, Harvie HS, Asfaw TS, Arya LA. Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse. Int J Gynaecol Obstet 2011; 111:237-40. [PMID: 20817179 DOI: 10.1016/j.ijgo.2010.06.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/08/2010] [Accepted: 08/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine whether the presence of obstructive defecatory symptoms is associated with the site and severity of pelvic organ prolapse. METHODS A cross-sectional study was performed of women with pelvic organ prolapse of grade 2 or greater who had completed a validated questionnaire that surveyed pelvic floor symptoms. Associations between patient characteristics, site and severity of prolapse, and obstructive bowel symptoms were investigated. RESULTS Among 260 women with pelvic organ prolapse, women with posterior vaginal wall prolapse were more likely to report obstructive symptoms, such as incomplete emptying (41% vs 21%, P=0.003), straining at defecation (39% vs 19%, P=0.002), and splinting with defecation (36% vs 14%, P<0.001) compared with women without posterior vaginal wall prolapse. There was no significant association between any bowel symptom and increasing severity of prolapse. CONCLUSIONS Obstructive bowel symptoms are significantly associated with the presence of posterior vaginal wall prolapse, but not with the severity of prolapse.
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Affiliation(s)
- Emily K Saks
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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