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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References
Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166
Handa VL, Garrett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 190(1):27–32
Cundiff GW, Fenner D (2004) Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol 104(6):1403–1421
Grimes CL, Tan-Kim J, Nager CW et al (2014) Outcome measures to assess anatomy and function of the posterior vaginal compartment. Int Urogynecol J 25(7):893–899
Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113
Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10(1):84–88
Lewis SJ, Heaton KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32(9):920–924
Bradley CS, Brown MB, Cundiff GW et al (2006) Bowel symptoms in women planning surgery for pelvic organ prolapse. Am J Obstet Gynecol 195(6):1814–1819
Dua A, Radley S, Brown S, Jha S, Jones G (2012) The effect of posterior colporrhaphy on anorectal function. Int Urogynecol J 23(6):749–753
Gustilo-Ashby AM, Paraiso MF, Jelovsek JE, Walters MD, Barber MD (2007) Bowel symptoms 1 year after surgery for prolapse: further analysis of a randomized trial of rectocele repair. Am J Obstet Gynecol 197(1):76.e1–76.e5
Abramov Y, Gandhi S, Goldberg RP, Botros SM, Kwon C, Sand PK (2005) Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol 105(2):314–318
Sloots CE, Meulen AJ, Felt-Bersma RJ (2003) Rectocele repair improves evacuation and prolapse complaints independent of anorectal function and colonic transit time. Int J Colorectal Dis 18(4):342–348
Porter WE, Steele A, Walsh P, Kohli N, Karram MM (1999) The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol 181(6):1353–1358, discussion 1358–9
Polin MR, Gleason JL, Szychowski JM, Holley RL, Richter HE (2012) Effects of transvaginal repair of symptomatic rectocele on symptom specific distress and impact on quality of life. J Gynaecol Obstet 117(3):224–227
Kahn MA, Stanton SL (1997) Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 104(1):82–86
Grimes CL, Lukacz ES, Gantz MG et al (2014) What happens to the posterior compartment and bowel symptoms after sacrocolpopexy? Evaluation of 5-year outcomes from E-CARE. Female Pelvic Med Reconstr Surg 20(5):261–266
Kaser DJ, Kinsler EL, Mackenzie TA, Hanissian P, Strohbehn K, Whiteside JL (2012) Anatomic and functional outcomes of sacrocolpopexy with or without posterior colporrhaphy. Int Urogynecol J 23(9):1215–1220
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Statistical Analysis: NIH CTSA grant UL RR031980 and UL1TR000100
AUGS Foundation Grant
Conflicts of interest
Grimes: Grant/research support from an American Urogynecologic Society (AUGS) Foundation Grant.
Tan-Kim, Nager, Menefee, Diwadkar, Overholser, Xu: None.
Dyer: Research support from Pelvalon.
Lukacz: Consultant to American Medical Systems/Astora, Axonics Inc., and Renew Medical; research support from Boston Scientific, Pfizer, and Uroplasty; royalties from UptoDate.
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Grimes, C.L., Overholser, R.H., Xu, R. et al. Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy. Int Urogynecol J 27, 1817–1823 (2016). https://doi.org/10.1007/s00192-016-3046-0
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DOI: https://doi.org/10.1007/s00192-016-3046-0