Abstract
We retrospectively reviewed 106 cases of defect-directed rectocele repair. Preoperative standardized evaluation of rectovaginal septum support was performed. Support defects were identified at surgery by visually identifying breaks in the rectovaginal fascia. Clinical and surgical findings were compared using the χ2 test. Logistic regression analysis was used to identify predictive variables. Clinical examination concurred with surgical findings in 59.4% (63/106) and differed in 40.6% (43/106). Predictors of agreement between clinical examination and intraoperative findings were the presence of multiple defects in the rectovaginal fascia at surgery (OR 4.42, 95% CI 1.89, 10.35) and stage II or III prolapse (OR 0.0007, 95% CI 0.00059, 0.003 and 0.0003, 95% CI 0.00033, 0.0017, respectively). The sensitivity and positive predictive value for all defects was less than 40%. The inaccuracy of clinical examination emphasizes the need to develop new clinical and/or imaging methods to evaluate posterior vaginal support defects.
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Editorial Comment: The authors tackle an important question—what is the relationship between physical exam and surgical findings in the posterior wall. Their retrospective analysis of 106 patients is an important first step. There is a bit of self-fulfilling prophecy when patients are selected for a "defect-based" repair and the surgeon correlates his/her own selection. Others may wish to repeat this analysis with a series of patients, however the measure by physical exam and surgery would be masked whenever possible. The authors are encouraged to continue this important line of investigation, hopefully correlating symptoms in the near future. Clinical evaluation of posterior vaginal wall defect location is inaccurate when comparing preoperative estimation with surgical findings on defect-directed rectocele repair.
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Burrows, L.J., Sewell, C., Leffler, K.S. et al. The accuracy of clinical evaluation of posterior vaginal wall defects. Int Urogynecol J 14, 160–163 (2003). https://doi.org/10.1007/s00192-002-1019-y
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DOI: https://doi.org/10.1007/s00192-002-1019-y