International Urogynecology Journal

, Volume 28, Issue 1, pp 49–57 | Cite as

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

  • Lene Duch MadsenEmail author
  • Emil Nüssler
  • Ulrik Schiøler Kesmodel
  • Susanne Greisen
  • Karl Møller Bek
  • Marianne Glavind-Kristensen
Original Article



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.


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.


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.


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.


Colporrhaphy National register data Non absorbable mesh Patient-reported outcome Rectocele 



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

Author contribution

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

Compliance with ethical standards


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).

Financial disclaime


Conflicts of interest

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


  1. 1.
    Maher C (2013) Pelvic organ prolapse surgery. In: Adams P (ed) 5th ICI. International Continence Society. p. 1377–442. Available from:
  2. 2.
    Dällenbach P (2015) To mesh or not to mesh : a review of pelvic organ reconstructive surgery. Int J Women’s Heal 7:331–343CrossRefGoogle Scholar
  3. 3.
    Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R et al (2012) One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 206(1):86.e1-9CrossRefPubMedGoogle Scholar
  4. 4.
    Skala CE, Renezeder K, Albrich S, Puhl A, Laterza RM, Naumann G et al (2015) Mesh complications following prolapse surgery: management and outcome. Eur J Obstet Gynecol Reprod Biol 159(2):453–456. doi: 10.1016/j.ejogrb.2011.07.024 CrossRefGoogle Scholar
  5. 5.
    Badlani G, Shah H (2012) Mesh complications in female pelvic floor reconstructive surgery and their management: a systematic review. Indian J Urol 28(2):129–153CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ellington DR, Richter HE (2013) The role of vaginal mesh procedures in pelvic organ prolapse surgery in view of complication risk. Obstet Gynecol Int 2013:356960. Available from:
  7. 7.
    Marshall S, Haywood K, Fitzpatrick R (2006) Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract 12(5):559–568. doi: 10.1111/j.1365-2753.2006.00650.x CrossRefPubMedGoogle Scholar
  8. 8.
    Nüssler E, Kesmodel U, Löfgren M, Nüssler E (2015) Operation for primary cystocele with anterior colporrhaphy or nonabsorbable mesh: patient-reported outcomes. Int Urogynecol J 26(3):359–366. doi: 10.1007/s00192-014-2511-x CrossRefPubMedGoogle Scholar
  9. 9.
    Pakbaz M, Mogren I, Löfgren M (2010) Outcomes of cystocele repair surgery in relation to different anesthesia methods. Acta Obstet Gynecol Scand 89(7):876–881CrossRefPubMedGoogle Scholar
  10. 10.
    Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyren O, Hammarström M (2015) A short-form questionnaire identified genital organ prolapse. J Clin Epidemiol 58(1):41–46. doi: 10.1016/j.jclinepi.2004.06.008 CrossRefGoogle Scholar
  11. 11.
    Ladfors MB, Löfgren OME, Gabriel B, Olsson J-HA (2002) Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 81(5):437–442. doi: 10.1034/j.1600-0412.2001.810511.x CrossRefPubMedGoogle Scholar
  12. 12.
    Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JOL, Klarskov P et al (2016) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17. doi: 10.1016/S0002-9378(96)70243-0 CrossRefGoogle Scholar
  13. 13.
    Weber AM (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J 12(3):178–186CrossRefGoogle Scholar
  14. 14.
    Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S et al (2012) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J 23(5):527–535. doi: 10.1007/s00192-012-1726-y CrossRefPubMedGoogle Scholar
  15. 15.
    Paraiso MFR, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195(6):1762–1771. Available from:
  16. 16.
    dos Reis Brandão da Silveira S, Haddad J, de Jármy-Di Bella Z, Nastri F, Kawabata M, da Silva Carramão S et al (2015) Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment. Int Urogynecol J 26(3):335–342. doi: 10.1007/s00192-014-2501-z CrossRefPubMedGoogle Scholar
  17. 17.
    Iglesia CB, Sokol AI, Sokol ER, Kudish BI, Gutman RE, Peterson JL et al (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116(2 Pt 1):293–303CrossRefPubMedGoogle Scholar
  18. 18.
    Gutman RE, Nosti P a, Sokol AI, Sokol ER, Peterson JL, Wang H, et al (2013) Three-year outcomes of vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 122(4):770–777. Available from:
  19. 19.
    Carey M, Higgs P, Goh J, Lim J, Leong A, Krause H et al (2009) Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG An Int J Obstet Gynaecol 116(10):1380–1386CrossRefGoogle Scholar
  20. 20.
    Baessler K (2012) Do we need meshes in pelvic floor reconstruction? World J Urol 30(4):479–486. doi: 10.1007/s00345-011-0794-9 CrossRefPubMedGoogle Scholar
  21. 21.
    Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. Int Braz J Urol 37(5):675CrossRefGoogle Scholar
  22. 22.
    Deffieux X, Letouzey V, Savary D, Sentilhes L, Agostini A, Mares P et al (2015) Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 165(2):170–180. doi: 10.1016/j.ejogrb.2012.09.001 CrossRefGoogle Scholar
  23. 23.
    Sardeli C, Axelsen SM, Kjaer D, Bek KM (2007) Outcome of site-specific fascia repair for rectocele. Acta Obstet Gynecol Scand 86(8):973–977. doi: 10.1080/00016340701444905/full CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  • Lene Duch Madsen
    • 1
    Email author
  • Emil Nüssler
    • 2
  • Ulrik Schiøler Kesmodel
    • 3
  • Susanne Greisen
    • 1
  • Karl Møller Bek
    • 1
  • Marianne Glavind-Kristensen
    • 1
  1. 1.Department of Obstetrics and GynecologyAarhus University HospitalAarhus NDenmark
  2. 2.Department of Clinical Science, Obstetrics and GynecologyUmeå UniversityUmeåSweden
  3. 3.Department of Obstetrics and GynecologyHerlev University HospitalHerlevDenmark

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