Patient goals after operation in the posterior vaginal compartment

OBJECTIVE

Success after operation for a pelvic organ prolapse in the posterior vaginal compartment is often related to restoration of anatomy, but success for the patient is linked to achievement of patient-reported goals. We investigated patient-reported goals after an operation in the posterior compartment and to which extent the goals had been achieved.

STUDY DESIGN

A prospective case series study including 87 women undergoing operation in the posterior compartment at Aalborg University Hospital. The women were asked to list up to three goals they wished to fulfil with the operation. Three months after surgery a telephone interview was conducted in which the women were asked whether each single goal was fulfilled, partly fulfilled or not fulfilled and to estimate the extent to which the goals had been achieved on a VAS scale from 1 to 10.

RESULTS

All patient-reported goals were divided into eight groups: 1: bulging, 2: bowel problems, 3: urinary problems, 4: sexual problems, 5: psychological problems, 6: physical activity, 7: pain and 8: others. A total of 233 goals were stated. Most goals were related to bowel problems (37.3%) and bulging (21.0%). Median total VAS score was 9. Overall 58.8% of all goals were categorized as fulfilled and 22.3% as partly fulfilled. Fulfilled goals were 83.7% in the group with bulging problems, sexuality problems 65%, and bowel problems 57.5%. Urinary problems had fewest fulfilled goals (18.5%). Bowel problems were further divided into evacuation problems, incontinence, constipation and others. Goals concerning evacuation problems were most often fulfilled (76.1%), and goals concerning anal incontinence were rarely fulfilled (25.0%).

CONCLUSIONS

Approximately 80% of the patient-reported goals after posterior compartment operation were fulfilled or partly fulfilled. Most goals were related to bowel problems and bulging. Bowel problems in the form of evacuation problems were more often solved than incontinence and constipation, and women should be advised about this. All goals should be discussed with the patient prior to an operation.

The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial

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.

Site-specific colporrhaphy in posterior compartment pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

A posterior vaginal wall prolapse is the result of specific tears in the rectovaginal fascia. The prevalence of the different defect types (superior, inferior, overstretching) is unknown, as is the subjective results after operation according to defect type. The aims of this retrospective study were to investigate the prevalence of the different injury sites and the subjective effects after an operation concerning the symptomatic feeling of a vaginal bulge and urinary incontinence in relation to defect types.

METHODS

Medical case records and data from the national Danish urogynecological database in patients with a prolapse operation including posterior vaginal wall prolapse for a 6-year period were reviewed. Four hundred and five patients were included. Patients completed the International Consultation on Incontinence-Urinary Incontinence Short Form and three questions on vaginal prolapse symptoms before and 3 months postoperatively.

RESULTS

The majority of women suffered from a superior defect (77 %). There was a statistically significant improvement in prolapse symptoms after surgery, with no difference between patients with different defect types. Patients with a superior defect and overstretching also experienced a statistically significant improvement in urinary incontinence.

CONCLUSIONS

The superior defect was the most common defect in the rectovaginal fascia. Patients experienced an improvement in subjective prolapse symptoms concerning the feeling of a vaginal bulge with no difference regarding defect type. Patients with a superior defect or overstretching experienced a statistically significant improvement in urinary incontinence. Similar results were found whether or not concomitant prolapse operations were performed in other compartments.