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ANZ Journal of Surgery Oct 2017Transperineal rectocele repairs, either as isolated fascial repair or in combination with mesh augmentation, are hypothesized to reduce the risk of complications... (Comparative Study)
Comparative Study Review
BACKGROUND
Transperineal rectocele repairs, either as isolated fascial repair or in combination with mesh augmentation, are hypothesized to reduce the risk of complications compared with alternative techniques.
AIM
The aim of this study was to ascertain long-term success and complication rates following transperineal rectocele repairs.
METHOD
A literature search of PubMed and Embase was performed using the terms 'transperineal rectocele', 'rectocele', 'transperineal' and 'repair'. Prospective studies, case series and retrospective case note analyses from 1 January 1994 to 1 December 2016 were included. Those that detailed outcomes of the transperineal approach or compared it to transanal/transvaginal approaches were included. The main outcome measures were reported complications and functional outcome scores.
RESULTS
A total of 14 studies were included. Of 566 patients, 333 (58.8%) underwent a transperineal rectocele repair and 220 (41.2%) a transanal repair. Complications were identified in 27 (12.3%) of the 220 transanal repairs and in 41 (12.3%) of the 333 transperineal repairs. A significant complication following transperineal repair was noted in eight studies. There are not enough data to make a reliable comparison between mesh and non-mesh transperineal repairs or to compare biological and synthetic mesh use.
LIMITATIONS
Outcome reporting differed between studies, precluding a full meta-analysis.
CONCLUSION
Transperineal rectocele repair offers an effective method of symptom improvement and appears to have a similar complication rate as transanal rectocele repair. Concomitant use of synthetic and biological mesh augmentation is becoming more common; however, high-quality comparative data are lacking, so a direct comparison between surgical approaches is not yet possible.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Perineum; Postoperative Complications; Prospective Studies; Quality of Life; Recovery of Function; Rectocele; Rectum; Retrospective Studies; Surgical Mesh; Treatment Outcome
PubMed: 28871666
DOI: 10.1111/ans.14068 -
Gastroenterology Clinics of North... Mar 2022Constipated patients are frequently referred to gastroenterologists for symptoms refractory to lifestyle modifications and laxatives. Dyssynergic defecation, the... (Review)
Review
Constipated patients are frequently referred to gastroenterologists for symptoms refractory to lifestyle modifications and laxatives. Dyssynergic defecation, the dyscoordination of rectoanal, abdominal, and pelvic floor muscles to facilitate defecation, is a major cause of refractory primary constipation. Understanding of the diagnosis, evaluation, and management of dyssynergic defecation and other evacuation disorders will allow providers to effectively manage these patients. This review focuses on the definition, pathophysiology, evaluation, and treatment of dyssynergic defecation and other evacuation disorders. Emerging treatments for these disorders include home biofeedback therapy for dyssynergic defecation and translumbosacral neuromodulation therapy for levator ani syndrome.
Topics: Ataxia; Biofeedback, Psychology; Constipation; Defecation; Humans; Laxatives
PubMed: 35135665
DOI: 10.1016/j.gtc.2021.10.004 -
Medicine Dec 2023The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous...
The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.
Topics: Infant, Newborn; Female; Humans; Pregnancy; Adolescent; Young Adult; Adult; Cystocele; Rectocele; Cesarean Section; Prospective Studies; Hernia
PubMed: 38134086
DOI: 10.1097/MD.0000000000036720 -
Urogynecology (Philadelphia, Pa.) Jul 2023There is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse.
IMPORTANCE
There is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse.
OBJECTIVES
The aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes.
STUDY DESIGN
This was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable.
RESULTS
One hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59-11.34; P < 0.01) as was advanced PVWP stage ( P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms ( P = 0.02).
CONCLUSIONS
We demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not.
Topics: Female; Humans; Rectocele; Uterine Prolapse; Pelvic Organ Prolapse; Physical Examination; Radiology
PubMed: 36701286
DOI: 10.1097/SPV.0000000000001330 -
Obstetrics & Gynecology Science Mar 2023Pelvic organ prolapse (POP) is a significant public health concern in women and a common cause of gynecological surgery in elderly women. The prevalence of POP has...
Pelvic organ prolapse (POP) is a significant public health concern in women and a common cause of gynecological surgery in elderly women. The prevalence of POP has increased with an increase in the aging population. POP is usually diagnosed based on pelvic examination. However, an imaging study may be necessary for more accurate diagnosis. Translabial ultrasound (TLUS) was used to assess diverse types of POP, particularly posterior-compartment POP. It is beneficial to distinguish between true and false rectocele, and detect the rectocele as clinically apparent. TLUS can also establish whether the underlying cause is a problem of the rectovaginal septum, perineal hypermobility, or isolated enterocele. TLUS also plays a role in differentiating POP from conditions that mimic POP. It is a simple, inexpensive, and non-harmful diagnostic modality that is appropriate for most gynecologic clinics.
PubMed: 36575051
DOI: 10.5468/ogs.22227 -
Current Urology Reports Jan 2017Pelvic organ prolapse (POP) is a generalized term that refers to prolapse of any of the three vaginal compartments: anterior (cystocele), posterior (rectocele), and... (Review)
Review
Pelvic organ prolapse (POP) is a generalized term that refers to prolapse of any of the three vaginal compartments: anterior (cystocele), posterior (rectocele), and apical (uterine and vault prolapse). POP may affect up to 50% of parous women, and as a result, one in nine women will undergo at least one surgery for POP in her lifetime. Native tissue repair is the cornerstone of prolapse surgery, especially in light of the scrutiny placed on the use of mesh for prolapse. Refinements in the procedures over time have been based on both basic anatomy and fundamentals of surgery, as well as the ongoing acquisition of new knowledge through clinical studies.
Topics: Cystocele; Female; Gynecologic Surgical Procedures; Humans; Pelvic Organ Prolapse; Rectocele; Treatment Outcome; Vagina
PubMed: 28155202
DOI: 10.1007/s11934-017-0648-0 -
The Urologic Clinics of North America Feb 2019Pelvic organ prolapse is common in parous women, although few report symptoms. The incidence of posterior compartment prolapse, or rectocele, is less well-reported.... (Review)
Review
Pelvic organ prolapse is common in parous women, although few report symptoms. The incidence of posterior compartment prolapse, or rectocele, is less well-reported. Posterior vaginal wall prolapse is associated with pain, constipation, and splinting. Surgery is the mainstay of therapy for symptomatic rectoceles. Though several surgical techniques have been described, no clear indications for type of repair have emerged. This article reviews the management strategies and draws conclusions about suture-based and site-specific techniques.
Topics: Female; Gynecologic Surgical Procedures; Humans; Pelvic Organ Prolapse; Rectocele; Recurrence; Risk Factors; Suture Techniques; Vagina
PubMed: 30466705
DOI: 10.1016/j.ucl.2018.08.007 -
American Journal of Medical Genetics.... Mar 2017Current evidence suggests that an association exists between non-inflammatory hereditary disorders of connective tissue such as the Ehlers-Danlos syndromes (EDS) and... (Review)
Review
Current evidence suggests that an association exists between non-inflammatory hereditary disorders of connective tissue such as the Ehlers-Danlos syndromes (EDS) and gastrointestinal (GI) symptoms. Patients with EDS can present with both structural problems such as hiatus hernias, visceroptosis, rectoceles, and rectal prolapse as well as functional problems such as disordered gut motility. It has recently been demonstrated that patients with hypermobile EDS (hEDS) present with GI symptoms related to the fore and hind-gut and these patients frequently meet the criteria for functional gastrointestinal disorders such as functional dyspepsia and irritable bowel syndrome. Presence of GI symptoms in EDS patients influences their quality of life. Specific evidence based management guidelines for the management of GI symptoms in EDS patients do not exist and these patients are often treated symptomatically. There is, however, recognition that certain precautions need to be taken for those patients undergoing surgical treatment. Future studies are required to identify the mechanisms that lead to GI symptoms in patients with EDS and more specific treatment guidelines are required. © 2017 Wiley Periodicals, Inc.
Topics: Disease Management; Ehlers-Danlos Syndrome; Gastrointestinal Diseases; Humans; Practice Guidelines as Topic; Quality of Life
PubMed: 28186368
DOI: 10.1002/ajmg.c.31546 -
International Urogynecology Journal Oct 2018Rectocele is common in parous women but also seen in nulliparae. This study was designed to investigate the association between vaginal parity and descent of the rectal... (Observational Study)
Observational Study
INTRODUCTION AND HYPOTHESIS
Rectocele is common in parous women but also seen in nulliparae. This study was designed to investigate the association between vaginal parity and descent of the rectal ampulla/rectocele depth as determined by translabial ultrasound (TLUS).
METHODS
This retrospective observational study involved 1296 women seen in a urogynaecological centre. All had undergone an interview, clinical examination and 4D ultrasound (US) imaging supine and after voiding. Offline analysis of volume data was undertaken blinded against other data. Rectal ampulla position and rectocele depth were measured on Valsalva. A pocket depth of 10 mm was used as a cutoff to define rectocele on imaging.
RESULTS
Most women presented with prolapse (53%, n = 686); 810 (63%) complained of obstructed defecation (OD). Clinically, 53% (n = 690) had posterior-compartment prolapse with a mean Bp of -1 [standard deviation (SD)1.5; -3 to 9 cm]. Mean descent of the rectal ampulla was 10 mm below the symphysis (SD 15.8; -50 to 41). A rectocele on imaging was found in 48% (n = 618). On univariate analysis, OD symptoms were strongly associated with rectal descent, rectocele depth and rectocele on imaging (all P < 0.001). The prevalence of a rectocele seen on imaging increased with vaginal parity (P < 0.001). One-way analysis of variance (ANOVA) of vaginal parity against rectal descent and rectocele depth showed a dose-response relationship (both P < 0.001).
CONCLUSIONS
Vaginal parity was strongly associated with descent of the rectal ampulla and rectocele depth. This relationship approximated dose-response characteristics, with the greatest effect due to the first vaginal delivery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Constipation; Defecation; Delivery, Obstetric; Female; Humans; Middle Aged; Parity; Pelvic Organ Prolapse; Pregnancy; Prevalence; Rectocele; Rectum; Retrospective Studies; Risk Factors; Ultrasonography; Vagina; Young Adult
PubMed: 29464300
DOI: 10.1007/s00192-017-3552-8