Rectoceles: value of videodefaecography in selection of treatment policy

Abstract

Videodefaecography allows identification of three different types of rectoceles: type I or digitiform rectocele, type II or rectocele with a lax rectovaginal septum, an anterior mucosal prolapse and a deep pouch of Douglas, and a type III in which a rectocele is associated with intussusception or even rectal prolapse. Furthermore, videodefaecography gave information on functional mechanisms resulting in incontinence or constipation. Surgical treatment should be tailored to the radiological and clinical findings: endoanal approach in type I, posterior colpomyorhaphy in type II and double abdomino-vaginal approach in type III. One hundred and fifty cases were prospectively treated according to this policy. Recurrence occurred in one out of 150 cases (1.3%). Incontinence was cured in 93% and constipation in 88%.

A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation, a comparison with defecography

“…Anorectocele was defined as any outpouching of the anterior upper anal canal and rectal wall occurring during straining. It was measured perpendicularly to the expected contour of the anterior rectal wall and quantified according to the classification proposed by Marti et al [14] (grade 1: 2.0 cm; grade II: 2.0-4.0 cm; grade III: >4.0 cm).…”

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

“…Radiologic methods for the dynamic evaluation of the obstruc ted defecation syndrome (ODS) include defecography, magnetic resonance imaging and ultrasonography, each of which has its advantages and limitations (4,5,6,10,14,20,22,24,25,28,32) . Different dynamic ultrasound techniques have been used to evaluate pelvic floor dysfunctions and demonstrated good correlation with conventional defecography (4,6,10,28) .…”

The influence of age on posterior pelvic floor dysfunction in women with obstructed defecation syndrome

“…PFD may therefore affect a range of different structures, producing a spectrum of isolated or associated clinical symptoms, including urinary and anal incontinence, pelvic organ prolapse and ODS. PFD may be evaluated by a combination of clinical and radiological examinations, including defecography, dynamic US and dynamic MRI [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Recent advances in US probe technology have made it possible to conduct detailed studies on the anatomy of the anal canal and pelvic floor, and new US modalities have been developed which can evaluate all pelvic floor compartments [23][24][25].…”