Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy

Abstract

Introduction and hypothesis We hypothesized that there would be a significant difference in changes in obstructed defecation symptoms and posterior compartment prolapse between women who underwent posterior vaginal wall prolapse repair (PR) and those who did not. Methods This was a two-site prospective cohort study of women undergoing prolapse or incontinence surgery in which a PR was, or was not, performed at the discretion of the surgeon. Women were assessed using validated obstructed defecation questionnaires and standardized examination measures (including POP-Q, measurement of transverse gh, and assessment for a rectovaginal pocket and laxity) prior to pelvic surgery and 12 weeks after surgery. Results Of 68 women who underwent surgery, 43 had PR. The PR group had higher obstructed defecation symptoms and greater posterior compartment prolapse at baseline. At 12 weeks, obstructed defecation symptoms had improved significantly more in the PR group than in the no PR group (all p < 0.03). Anatomic outcomes showed greater improvement in point Bp in the PR group (−3.4 vs. −0.7 no PR, p < 0.001) and resolution of the rectovaginal pocket (86 % vs. 42 %, p = 0.002). There were no significant changes in obstructed defecation symptoms or anatomic outcomes from baseline in the no PR group, while the PR group showed significantly improved obstructed defecation symptoms and anatomic outcomes after repair (p < 0.001 for both). Conclusions Significant improvements in obstructed defecation symptoms and posterior compartment prolapse were seen after PR, but not in women who did not receive PR. Obstructed defecation symptoms, Bp and rectovaginal pocket were the measures best able to demonstrate improvement after PR. We recommend the use of these measures to assess the impact of surgery in the posterior compartment.

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series

“…In the study, 40% of the patients had previous pelvic surgery and 59% of them reported at least some symptom of obstructed defecation. 4 In the present study, the mean age of the patients was 63.8 years. Fifteen patients (75%) had vaginal deliveries, with an average of 3 deliveries/patient.…”

“…Disorders of the middle/posterior pelvic floor are complex, and it is difficult to correlate the symptoms (incomplete evacuation, fecal impaction, use of fingers to aid in the removal of stool and defecation effort) and the associated anatomical defects. Grimes et al 4 compared the surgical repair of the vaginal posterior wall prolapse associated or not with other pelvic procedures and concluded that this anatomical repair of the posterior compartment significantly improved all symptoms associated with evacuation difficulties, including fecal incontinence. In the study, 40% of the patients had previous pelvic surgery and 59% of them reported at least some symptom of obstructed defecation.…”

“…The obstetric history, with late and prolonged births and previous pelvic surgeries, such as hysterectomy, aggravate the problem. 4 The patients report that the stool reaches the anus, but they are unable to eliminate it, requiring much effort. As a result, anal problems such as hemorrhoids and fissures worsen, as well as rectal intussusception and, ultimately, prolapse of pelvic organs.…”

“…As a result, anal problems such as hemorrhoids and fissures worsen, as well as rectal intussusception and, ultimately, prolapse of pelvic organs. 4 Pelvic floor dysfunction is a complex condition. This muscle-ligament structure divided into three compartments -anterior (bladder and urethra), middle (uterus and vagina) and posterior (rectum) -must be understood as a unit.…”

Early Safety and Efficiency Outcomes of a Novel Standardized Interdisciplinary Procedure of Combined Laparoscopic Resection Rectopexy with Laparoscopic Sacrocolpopexy to Treat Obstructive Defecation Syndrome in Women with Pelvic Organ Prolapse

“…The surgical treatment aims at the anatomic reconstruction of the bowel and pelvic oor (14,15) and has been characterized by individual approaches. By ignoring the complexity of the underlying condition, the desired results are often missed (oder besseres Wort ?)…”