Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Abstract

Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

One‐year follow‐up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery

“…The findings of the present study are consistent with published data on the benefits of reconstructing the perineal body 14,34,36 . Bergman et al showed an improvement in patient satisfaction after perineal reconstructive surgery when compared with physiotherapy 12 . Correspondingly, in this study, the total postoperative scores were greatly reduced, and the item score “Are you experiencing genital discomfort that affects your quality of life?” was significantly decreased, which may be interpreted as high patient satisfaction.…”

“…The procedure of perineorrhaphy or perineoplasty is commonly performed concomitant to posterior colporrhaphy 11 . As shown in a randomized control trial by Bergman et al, perineal reconstruction seem to reduce complaints of pelvic floor dysfunction 12 . However, there is a heterogeneity in procedure description and surgical approaches, which are all used interchangeably 13,14 .…”

Effect of Pelvic Floor Muscle Training With Smartphone Reminders on Women in the Postpartum Period: A Randomized Controlled Trial

“…The training principles were as follows: 10 maximal contractions, each 5 seconds long, 3 times per day, and 1 maximal contraction of 30-60 seconds; continue training for 3 months. 22 No other physical examination was performed by the physiotherapist. The researchers used the smartphone application WeChat to send prewritten messages to participants in the intervention group at 9 am, 2 pm, and 6 pm every day to remind them to perform PFMT.…”

Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial

“…Third-and fourth-degree injuries are regarded as ‘high order’ since they are associated with higher risk of urogynaecological, sexual and colon-proctological dysfunctions than in first- and second-degrees [ 4 , 5 ]. Prevalence in developed countries varies, reaching 10.2% in women who had vaginal birth, although there is recognised lack of standardisation in perineal tear identification and is also under-diagnosed on numerous occasions [ 6 , 7 ]. All of these factors added to those that have an impact on women’s health (dyspareunia, chronic pelvic pain, vaginal flatulence, urinary, faecal or anal incontinence, prolapses…) make it difficult to collect data on the economic impact of perineal tears in the in participating health service system [ 8 , 9 ].…”