Site-Specific Rectocele Repair Compared With Standard Posterior Colporrhaphy
ABSTRACT To compare the anatomic and functional outcomes of site-specific rectocele repair and standard posterior colporrhaphy.
We reviewed charts of all patients who underwent repair of advanced posterior vaginal prolapse in our institution between July 1998 and June 2002 with at least 1 year of follow-up.
This study comprised 124 consecutive patients following site-specific rectocele repair and 183 consecutive patients following standard posterior colporrhaphy without levator ani plication. Baseline characteristics, including age, body mass index, parity, previous pelvic surgeries, and preoperative prolapse were not significantly different between the 2 study groups. Recurrence of rectocele beyond the midvaginal plane (33% versus 14%, P = .001) and beyond the hymenal ring (11% versus 4%, P = .02), recurrence of a symptomatic bulge (11% versus 4%, P = .02), and postoperative Bp point (-2.2 versus -2.7 cm, P = .001) were significantly higher after the site-specific rectocele repair. Rates of postoperative dyspareunia (16% versus 17%), constipation (37% versus 34%), and fecal incontinence (19% versus 18%) were not significantly different between the 2 study groups.
Site-specific rectocele repair is associated with higher anatomic recurrence rates and similar rates of dyspareunia and bowel symptoms than standard posterior colporrhaphy.
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ABSTRACT: Sexual well-being is an important parameter of women's health and quality of live. Sexual disorders may occur in women with pelvic organ prolapse and/or stress urinary incontinence and also after pelvic reconstructive surgery. Sexual dysfunction after POP or SUI surgery has been poorly documented but new condition specific questionnaires have been developed to help us to better evaluate such consequences. This paper reports updated data and highlights more specifically consequences of surgery with mesh reinforcement which is, currently, an important issue particularly when performing by vaginal approach.Progrès en Urologie 12/2009; 19(13):1037-1059. DOI:10.1016/j.purol.2009.10.001 · 0.77 Impact Factor
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ABSTRACT: PurposeTo summarize the most important evidence available in the field of pelvic floor reconstruction surgery, as well as at indicating the proper methodology for studies in the field.MethodsA non systematic review of the literature was performed by means of MEDLINE search.ResultsThe available evidence supported the use of mesh in anterior vaginal wall prolapse surgery, the indications both for abdominal sacrocolpopexy in case of vaginal vault prolapse and posterior colporrhaphy in case of rectocele. In patients with vaginal vault prolapse, two recently published RCTs recommended the use of polypropylene mesh during sacrocolpopexy, as well as the use of a prophylactic concomitant anti-incontinence procedure, such as Burch colposuspension. However, the data regarding lower urinary tract, bowel, sexual functions, generic quality of life issues, and long-term outcome were insufficient.ConclusionsFew high-quality RCTs are available in the field of pelvic floor reconstruction. Further RCTs with long-term follow-up and attention to the assessment of functional outcomes by means of validated questionnaires and re-evaluation at longer follow-up of most of the currently available trials are strongly desired to improve evidence-based management in urogynecology.EAU-EBU Update Series 10/2006; DOI:10.1016/j.eeus.2006.07.003
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ABSTRACT: After pelvic organ prolapse repair, nearly 30% of women undergo additional surgical intervention for prolapse recurrence (1). Despite this fact, there are few published reports specifically examining prolapse recurrence and its optimal surgical management. Furthermore, the definition of a surgical failure is not always clear, as there are cases in which organ dysfunction may persist, despite a technically sound outcome, whereas some asymptomatic patients may have a recurrent low-grade or-stage prolapse.