Urogynecological Assessment and Perspective in Patients Presenting with Evacuatory Dysfunction
The gynecologic indications for enterocele and rectocele repair are more numerous compared with the traditional colorectal indications because gynecologists primarily address vaginal symptoms when repairing a rectocele. Here, obstructive defecation symptoms are only some of a list of accepted indications. Preoperative evaluation typically only includes clinical assessment gained from the history and physical examination, and gynecologists rarely depend on defecography to plan a reconstructive procedure for rectoceles. Overall, surgical correction success rates are quite high when using a vaginal approach for rectocele correction. Vaginal dissection results in better visualization and access to the endopelvic fascia and levator musculature, which allows for a “firmer” anatomic correction. In addition, maintaining rectal mucosal integrity appears to reduce the risk of postoperative infection and fistula formation. More comprehensive data collection is necessary to better understand the effect of various surgical techniques on vaginal, sexual, and defecatory symptoms in these patients who may present with complex symptomatology where the rectocele and/or enterocele represent the dominant clinical finding.
KeywordsPelvic Organ Prolapse Uterosacral Ligament Posterior Vaginal Wall Perineal Body Genital Prolapse
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- 4.Kapoor, Davila GW, Wexner SD, and Ghoniem G. Int Urogynecol J. 2001;12:S53.Google Scholar
- 5.Mizrahi, Kapoor, Nogueras JJ, Weiss E, Wexner SD, and Davila GW. ASCRS. 2002.Google Scholar
- 7.Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE, and Bump RC. Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996;175:1467–71.PubMedCrossRefGoogle Scholar
- 13.Shull BL and Bachofen CG. Enterocele and rectocele. In: Walters MD and Karram MM, editors. Urogynecology and reconstructive pelvic surgery. 2nd ed. St. Louis: Mosby; 1999. p. 221–34.Google Scholar
- 14.Brubaker L. Rectocele. Curr Opin Obstet Gynecol. 1996;8:376–9.Google Scholar
- 18.Moschcowitz AV. The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet. 1912;15:7–12.Google Scholar
- 20.Paraiso MF, Weber AM, Walters MD, Ballard LA, Piedmonte MR, and Skibinshi C. Anatomic and functional outcome after posterior colporrhaphy. J Pelvic Surg. 2001;7:335–9.Google Scholar
- 24.Francis WJ and Jeffcoate TN. Dyspareunia following vaginal operations. J Obstet Gynaecol Br Emp. 1961;68:1–10.Google Scholar
- 29.Fox SD and Stanton SL. Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition. Br J Obstet Gynaecol. 2000;107:1371–5.Google Scholar
- 32.Iglesia CB, Fenner DE, and Brubaker L. The use of mesh in gynecologic surgery. Int Urogynecol J. 1997;8:105–15.Google Scholar
- 35.Parker MC and Phillips RKS. Repair of rectocoele using Marlex mesh. Ann R Coll Surg Eng. 1993;75:193–4.Google Scholar
- 41.Sehapayak S. Transrectal repair of rectocele: An extended armamentarium of colorectal surgeons. Dis Colon Rectum. 1985;6:422–33.Google Scholar