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Native-tissue repair of isolated primary rectocele compared with nonabsorbable mesh: patient-reported outcomes

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Abstract

Introduction

We evaluated patient-reported outcomes and complications after treatment of isolated primary rectocele in routine health-care settings using native-tissue repair or nonabsorbable mesh.

Methods

We used prospective data from the Swedish National Register for Gynaecological Surgery and included 3988 women with a primary operation for rectocele between 2006 and 2014: 3908 women had native-tissue repair, 80 were operated with nonabsorbable mesh. No concurrent operations were performed. Pre- and perioperative data were collected from doctors and patients. Patient-reported outcomes were evaluated 2 and 12 months after the operation. Only validated questionnaires were used.

Results

One year after native-tissue repair, 77.8 % (76.4–79.6) felt they were cured, which was defined as never or hardly ever feeling genital protrusion; 74.0 % (72.2–75.7) were very satisfied or satisfied, and 84 % (82.8–85.9) reported improvement of symptoms. After mesh repair, 89.8 % (77.8–96.6) felt cured, 69.2 % (54.9–81.3) were very satisfied or satisfied, and 86.0 % (72.1–94.7) felt improvement. No significant differences were found between groups. Organ damage was found in 16 (0.4 %) patients in the native-tissue repair group compared with one (1.3 %) patient in the mesh group [odds ratio (OR) 3.08; 95 % confidence interval (CI) 0.07–20.30]. The rate of de novo dyspareunia after native-tissue repair was 33.1 % (30.4–35.8), comparable with that after mesh repair. The reoperation rate was 1.1 % (0.8–1.5) in both groups.

Conclusion

Most patients were cured and satisfied after native-tissue repair of the posterior vaginal wall, and the patient-reported outcomes were comparable with results after mesh repair. The risk of serious complications and reoperation were comparable between groups.

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Acknowledgments

The Swedish Association of Local Authorities and Regions supported this study.

Author contribution

LD Madsen: data setup and analysis, statistical analysis, writing process.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark

    Lene Duch Madsen, Susanne Greisen, Karl Møller Bek & Marianne Glavind-Kristensen

  2. Department of Clinical Science, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden

    Emil Nüssler

  3. Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark

    Ulrik Schiøler Kesmodel

Authors
  1. Lene Duch Madsen
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  2. Emil Nüssler
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  3. Ulrik Schiøler Kesmodel
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  4. Susanne Greisen
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  5. Karl Møller Bek
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  6. Marianne Glavind-Kristensen
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Corresponding author

Correspondence to Lene Duch Madsen.

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Consent

All women were informed that they could decline to participate in The Swedish National Register for Gynaecological Surgery. This study was approved by the Ethics Committee University of Umeå, Sweden (Dnr 08–076 M).

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The authors alone are responsible for the content and writing of the paper.

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Madsen, L.D., Nüssler, E., Kesmodel, U.S. et al. Native-tissue repair of isolated primary rectocele compared with nonabsorbable mesh: patient-reported outcomes. Int Urogynecol J 28, 49–57 (2017). https://doi.org/10.1007/s00192-016-3072-y

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  • DOI: https://doi.org/10.1007/s00192-016-3072-y

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