International Urogynecology Journal

, Volume 30, Issue 9, pp 1433–1454 | Cite as

Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations

  • Cara L. Grimes
  • Megan O. Schimpf
  • Cecilia K. Wieslander
  • Ambereen Sleemi
  • Paula Doyle
  • You (Maria) Wu
  • Ruchira Singh
  • Ethan M. Balk
  • David D. Rahn
  • for the Society of Gynecologic Surgeons (SGS) Systematic Review Group (SRG)
Original Article


Introduction and hypothesis

Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both conditions among different surgical approaches.


A systematic review was performed comparing the impact of surgical interventions in the posterior compartment on prolapse and defecatory symptoms. MEDLINE, Embase, and were searched from inception to 4 April 2018. Randomized controlled trials, prospective and retrospective comparative and single-group studies of women undergoing posterior vaginal compartment surgery for vaginal bulge or bowel symptoms were included. Studies had to include both anatomical and symptom outcomes both pre- and post-surgery.


Forty-six eligible studies reported on six surgery types. Prolapse and defecatory symptoms improved with native-tissue transvaginal rectocele repair, transanal rectocele repair, and stapled transanal rectocele repair (STARR) surgeries. Although prolapse was improved with sacrocolpoperineopexy, defecatory symptoms worsened. STARR caused high rates of fecal urgency postoperatively, but this symptom typically resolved with time. Site-specific posterior repairs improved prolapse stage and symptoms of obstructed defecation. Compared with the transanal route, native-tissue transvaginal repair resulted in greater improvement in anatomical outcomes, improved obstructed defecation symptoms, and lower chances of rectal injury, but higher rates of dyspareunia.


Surgery in the posterior vaginal compartment typically has a high rate of success for anatomical outcomes, obstructed defecation, and bulge symptoms, although these may not persist over time. Based on this evidence, to improve anatomical and symptomatic outcomes, a native-tissue transvaginal rectocele repair should be preferentially performed.


Obstructed defecation Rectocele Surgery Systematic review 



Funding provided by the Society of Gynecologic Surgeons (SGS) supports assistance by a methods expert in systematic reviews and other logistics.

Compliance with ethical standards

Conflicts of interest

CG provides expert testimony for Johnson and Johnson. The other authors declare that they have no conflicts of interest.


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Cara L. Grimes
    • 1
  • Megan O. Schimpf
    • 2
  • Cecilia K. Wieslander
    • 3
  • Ambereen Sleemi
    • 4
  • Paula Doyle
    • 5
  • You (Maria) Wu
    • 6
  • Ruchira Singh
    • 7
  • Ethan M. Balk
    • 8
  • David D. Rahn
    • 9
  • for the Society of Gynecologic Surgeons (SGS) Systematic Review Group (SRG)
  1. 1.Department of Obstetrics and GynecologyNew York Medical CollegeValhallaUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborUSA
  3. 3.Department of Obstetrics and GynecologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  4. 4.International Medical ResponseBrooklynUSA
  5. 5.Department of Obstetrics and Gynecology, Department of UrologyUniversity of Rochester School of Medicine and DentistryRochesterUSA
  6. 6.Department of Obstetrics and GynecologyLondon Health Sciences CentreLondonCanada
  7. 7.Department of Obstetrics and GynecologyUniversity of Florida College of Medicine—JacksonvilleJacksonvilleUSA
  8. 8.Center for Evidence Synthesis in Health, Brown School of Public HealthBrown UniversityProvidenceUSA
  9. 9.Department of Obstetrics and GynecologyUniversity of Texas Southwestern Medical CenterDallasUSA

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