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International Urogynecology Journal Jun 2024Colpocleisis is a surgical procedure intended to treat pelvic organ prolapse. Compared with other modes of pelvic reconstructive surgery, colpocleisis is associated with... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Colpocleisis is a surgical procedure intended to treat pelvic organ prolapse. Compared with other modes of pelvic reconstructive surgery, colpocleisis is associated with lower morbidity and higher satisfaction, and has a success rate of 91-100% and a reoperation rate of less than 2%. However, there is limited information on how to treat recurrent prolapse after colpocleisis.
METHODS
We performed a review of the existing literature regarding colpocleisis failure and retreatment. A total of 118 articles were reviewed, with 16 articles suitable for inclusion. We also describe a case from our own institution of a "repeat colpocleisis" for recurrent prolapse after previous colpocleisis.
RESULTS
"Repeat colpocleisis" was the most common surgical technique used (18 out of 24 patients, 75.0%). The median follow-up time after the repeat surgery was 12 months, with only 1 patient with recurrence reported owing to recurrent rectocele 2 years after surgery, treated successfully with perineorrhaphy. Other less common techniques included perineorrhaphy, reversal of colpocleisis with native tissue repair, and vaginal hysterectomy with vaginal repair. Our case report describes the surgical management of a patient who had previously undergone LeFort colpocleisis with recurrence of prolapse, subsequently undergoing repeat colpocleisis.
CONCLUSIONS
The colpocleisis failure, though rare, presents a surgical challenge owing to both its rarity and the paucity of information in the literature regarding the optimal mode of management. In this review, the most common technique for surgical management of colpocleisis failure was repeat colpocleisis, with good short-term success rates noted. Additional studies with longer-term follow-up are needed.
PubMed: 38942932
DOI: 10.1007/s00192-024-05852-x -
Biomedical Papers of the Medical... Dec 2023The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and...
AIMS
The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and MRI-defecography and, the association with psychiatric disorders.
METHODS
44 patients (median age 53.81 years) presenting with intestinal motility disorders and who underwent clinical, biological and psychiatric examination, dynamic defecographic-MRI (resting, squeezing, straining, defecation and evacuation phases), anorectal manometry, colonoscopy. MRI was performed using the 1,5 T.
RESULTS
MRI-defecography revealed the following changes: anismus (16), rectocele (12), pelvic floor dysfunction (6), peritoneocele (2), cervical-cystic-ptosis (1), rectal prolapse (6), and in 1 case the examination was normal. Hypertonic anal sphincter (16) and lack of defecation reflex (12) at anorectal manometry correlated with anismus in all patients at MRI-defecography. Lack of inhibitor anal reflex (6) was associated with rectocele (4), cervix-cysto-ptosis (1) and peritoneocele (2). Anxiety (11), depression (6) and anxiety-depressive disorders (10) were found in 27/44, somatization disorders in 9/44 and no psychiatric changes in 8/44 cases.
CONCLUSION
As multiparous women are at risk for outlet obstruction constipation, MRI-defecography is suggested in this category. There is good correlation between diagnosis using anorectal manometry and MRI-defecography in patients with terminal constipation and anismus. Lower defecation dysfunction is often associated with psychiatric disorders.
Topics: Humans; Female; Middle Aged; Defecation; Rectocele; Defecography; Retrospective Studies; Constipation; Magnetic Resonance Imaging
PubMed: 35582728
DOI: 10.5507/bp.2022.023 -
Radiologie (Heidelberg, Germany) Nov 2023Magnetic resonance defecography (MRD) plays a central role in diagnosing pelvic floor functional disorders by visualizing the entire pelvic floor along with pelvic... (Review)
Review
BACKGROUND
Magnetic resonance defecography (MRD) plays a central role in diagnosing pelvic floor functional disorders by visualizing the entire pelvic floor along with pelvic organs and providing functional assessment of the defecation process. A shared understanding between radiology and surgery regarding indications and interpretation of findings is crucial for optimal utilization of MRD.
OBJECTIVES
This review aims to explain the indications for MRD from a surgical perspective and elucidate the significance of radiological findings for treatment. It intends to clarify for which symptoms MRD is appropriate and which criteria should be followed for standardized results. This is prerequisite to develop interdisciplinary therapeutic approaches.
MATERIALS AND METHODS
A comprehensive literature search was conducted, including current consensus guidelines.
RESULTS
MRD can provide relevant findings in the diagnosis of fecal incontinence and obstructed defecation syndrome, particularly in cases of pelvic floor descent, enterocele, intussusception, and pelvic floor dyssynergia. However, rectocele findings in MRD should be interpreted with caution in order to avoid overdiagnosis.
CONCLUSION
MRD findings should never be considered in isolation but rather in conjunction with patient history, clinical examination, and symptomatology since morphology and functional complaints may not always correlate, and there is wide variance of normal values. Interdisciplinary interpretation of MRD results involving radiology, surgery, gynecology, and urology, preferably in the context of pelvic floor conferences, is recommended.
Topics: Female; Humans; Defecography; Pelvic Floor; Magnetic Resonance Imaging; Rectocele; Pelvic Floor Disorders; Surgeons
PubMed: 37831101
DOI: 10.1007/s00117-023-01213-9 -
Radiologie (Heidelberg, Germany) Nov 2023Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. The simultaneous detection of multiple... (Review)
Review
BACKGROUND
Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. The simultaneous detection of multiple findings in a complex anatomic setting renders correct analysis and clinical interpretation challenging.
OBJECTIVES
The most important aspects (anatomy of the pelvic floor, three compartment model, morphological and functional analysis, reporting) for a successful clinical use of dynamic MRI of the pelvic floor are summarized.
MATERIALS AND METHODS
Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panel of ESUR/ESGAR in 2016.
RESULTS
The pelvic floor is a complex anatomic structure, mainly formed by the levator ani muscle, the urethral support system and the endopelvic fascia. Firstly, morphological changes of these structures are analysed on the static sequences. Secondly, the functional analysis using the three compartment model is performed on the dynamic sequences during squeezing, straining and defecation. Pelvic organ mobility, pelvic organ prolapse, the anorectal angle and pelvic floor relaxation are measured and graded. The diagnosis of cystoceles, enteroceles, rectoceles, the uterovaginal as well as anorectal decent, intussusceptions and dyssynergic defecation should be reported using a structured report form.
CONCLUSIONS
A comprehensive analysis of all morphological and functional findings during dynamic MRI of the pelvic floor can provide information missed by other imaging modalities and hence alter therapeutic strategies.
Topics: Humans; Defecography; Pelvic Floor; Rectocele; Hernia; Magnetic Resonance Imaging
PubMed: 37783986
DOI: 10.1007/s00117-023-01223-7 -
Diseases of the Colon and Rectum May 2024Patient-centered educational resources surrounding rectal prolapse and rectocele can be difficult to locate and understand. Findings of video animation as...
BACKGROUND
Patient-centered educational resources surrounding rectal prolapse and rectocele can be difficult to locate and understand. Findings of video animation as patient-specific material for these conditions can help guide creation of effective educational tools for patients.
OBJECTIVE
To identify female patient preferences for learning about rectal prolapse and rectocele and to obtain feedback on an animation developed to aid patient education on these conditions.
DESIGN
This was a multiple methods study. Participants received a 20-question survey about educational preferences and a 100-second video animation on rectal prolapse and rectocele. Respondents were invited for a semi-structured interview to further express their thoughts regarding health education.
SETTING
This study was conducted from 2022 - 2023, surveys were administered via e-mail and interviews were held virtually.
PATIENTS
Female patients in the institutional review board-approved Stanford Rectal Prolapse Registry were included.
MAIN OUTCOME MEASURES
Assess and describe the ability of short video animations to supplement patient education on rectal prolapse and rectocele.
RESULTS
46 female participants responded and 10 were interviewed. About 97% of participants indicated the video animation explained the condition clearly, and 66% felt comfortable explaining the condition. Feedback suggested showing the animation during the first appointment and creating similar content for surgery preparation. Patient challenges while researching rectal prolapse and rectocele online included difficulty finding content (41.5%), complex language (18.8%) and uncertainty about source reliability (16.9%).
LIMITATIONS
Small sample size with little socioeconomic diversity and highly educated participants.
CONCLUSIONS
Patient-centered resources surrounding specific pelvic floor disorder(s) are not always readily accessible online. This study demonstrated the value of a short video animation to enhance patients' understanding of rectal prolapse and rectocele. See Video.
PubMed: 38713067
DOI: 10.1097/DCR.0000000000003345 -
Gastroenterologia Y Hepatologia Jun 2024Defecation disorders can occur as a consequence of functional or structural anorectal dysfunctions during voiding. The aims of this study is to assess the prevalence of...
BACKGROUND/AIMS
Defecation disorders can occur as a consequence of functional or structural anorectal dysfunctions during voiding. The aims of this study is to assess the prevalence of structural (SDD) vs functional (FDD) defecation disorders among patients with clinical complaints of obstructive defecation (OD) and their relationship with patients' expulsive capacity.
PATIENTS AND METHODS
Retrospective study of 588 patients with OD studied between 2012-2020 with evacuation defecography (ED), and anorectal manometry (ARM) in a subgroup of 294.
RESULTS
90.3% patients were women, age was 58.5±12.4 years. Most (83.7%) had SDD (43.7% rectocele, 45.3% prolapse, 19.3% enterocele, and 8.5% megarectum), all SDD being more prevalent in women except for megarectum. Functional assessments showed: a) absence of rectification of anorectal angle in 51% of patients and poor pelvic descent in 31.6% at ED; and b) dyssynergic defecation in 89.9%, hypertonic IAS in 44%, and 33.3% rectal hyposensitivity, at ARM. Overall, 46.4% of patients were categorised as pure SDD, 37.3% a combination of SDD+FDD, and 16.3% as having pure FDD. Rectal emptying was impaired in 66.2% of SDD, 71.3% of FDD and in 78% of patients with both (p=0.017).
CONCLUSIONS
There was a high prevalence of SDD in middle-aged women with complaints of OD. Incomplete rectal emptying was more prevalent in FDD than in SDD although FDD and SDD frequently coexist. We recommend a stepwise therapeutic approach always starting with therapy directed to improve FDD and relaxation of striated pelvic floor muscles.
PubMed: 38857752
DOI: 10.1016/j.gastrohep.2024.502219 -
Academic Radiology Sep 2023Most women with endometrial cancer (EC) have an excellent prognosis and may be cured. However, treatment-related pelvic functional impacts may affect long-term quality...
RATIONALE AND OBJECTIVES
Most women with endometrial cancer (EC) have an excellent prognosis and may be cured. However, treatment-related pelvic functional impacts may affect long-term quality of life. To better understand these concerns, we explored correlations between patient-reported outcomes and pelvic magnetic resonance imaging (MRI) features in women treated for EC.
MATERIALS AND METHODS
Women with histologic diagnosis of EC were consented preoperatively and completed the validated Female Sexual Function Index (FSFI) and Pelvic Floor Dysfunction Index (PFDI) questionnaires at preoperative, 6-week, and 6-month follow-up visits. Pelvic MRIs with dynamic pelvic floor sequences were performed at 6 weeks and 6 months.
RESULTS
A total of 33 women participated in this prospective pilot study. Only 53.7% had been asked about sexual function by providers while 92.4% thought they should have been. Sexual function became more important to women over time. Baseline FSFI was low, declined at 6 weeks, and climbed above baseline at 6 months. Hyperintense vaginal wall signal on T2-weighted images (10.9 vs. 4.8, p = .002) and intact Kegel function (9.8 vs. 4.8, p = .03) were associated with higher FSFI. PFDI scores trended toward improved pelvic floor function over time. Pelvic adhesions on MRI were associated with better pelvic floor function (23.0 vs. 54.9, p = .003). Urethral hypermobility (48.4 vs. 21.7, p = .01), cystocele (65.6 vs. 24.8, p < .0001), and rectocele (58.8 vs. 18.8, p < .0001) predicted worse pelvic floor function.
CONCLUSION
Use of pelvic MRI to quantify anatomic and tissue changes may facilitate risk stratification and response assessment for pelvic floor and sexual dysfunction. Patients articulated the need for attention to these outcomes during EC treatment.
Topics: Female; Humans; Quality of Life; Prospective Studies; Pilot Projects; Magnetic Resonance Imaging; Endometrial Neoplasms; Patient Reported Outcome Measures; Surveys and Questionnaires
PubMed: 37100674
DOI: 10.1016/j.acra.2023.03.031 -
BMC Psychiatry Feb 2024The symptoms of functional constipation (FC) were obviously affected by mental symptoms, which was consistent with somatic symptoms. However, the characteristics of FC...
BACKGROUND
The symptoms of functional constipation (FC) were obviously affected by mental symptoms, which was consistent with somatic symptoms. However, the characteristics of FC patients with somatic symptom remains unexplored.
METHODS
Clinical characteristics including somatic symptom (SOM, PHQ-15), depression (PHQ-9), anxiety (GAD-7), quality of life (PAC-QOL), constipation (KESS), demographic variables, anatomical abnormalities and symptoms were investigated. Subsequent analyses encompassed the comparison of clinical parameters between patients with SOM + group (PHQ-15 ≥ 10) and SOM- group (PHQ-15 < 10), subgroup analysis, correlation analysis, and logistic regression. Lastly, we evaluated the somatic symptom severity (SSS) among FC patients subjected to various stressors.
RESULTS
Notable disparities were observed between SOM + and SOM- groups in variety of physiological and psychological variables, including gender, stressful events, sleep disorders, reduced interest, GAD-7, PHQ-15, PHQ-9, PAC-QOL, anterior rectocele, KESS, and internal anal sphincter achalasia (IASA) (P < 0.05). Subgroup analysis affirmed consistent findings across mental symptoms. Correlation analyses revealed significant associations between SSS and KESS, anterior rectocele, GAD-7, PHQ-9, and PAC-QOL (P < 0.05). Logistic regression identified PHQ-9 (OR = 7.02, CI: 2.06-27.7, P = 0.003), GAD-7 (OR = 7.18, CI: 2.00-30.7, P = 0.004), and KESS (OR = 16.8, CI: 3.09-113, P = 0.002) as independent predictors of SSS. Elevated SSS scores were significantly associated with couple, parental, and work-related stressors (P < 0.05).
CONCLUSION
A marked heterogeneity was observed between SOM + and SOM- patients of FC, with SOM + accompanied by more severe constipation, anxiety and depression symptoms. This finding underscores the importance of considering somatic symptoms in diagnosis and treatment of FC.
Topics: Humans; Quality of Life; Cross-Sectional Studies; Medically Unexplained Symptoms; Rectocele; Surveys and Questionnaires; Outpatients; Anxiety; Depression; Constipation
PubMed: 38365647
DOI: 10.1186/s12888-024-05559-9 -
Frequency of cul-de-sac obliteration in surgery for pelvic organ prolapse: a retrospective analysis.Archives of Gynecology and Obstetrics Jun 2024We aimed to clarify the frequency of cul-de-sac obliteration in patients undergoing POP surgery.
INTRODUCTION AND HYPOTHESIS
We aimed to clarify the frequency of cul-de-sac obliteration in patients undergoing POP surgery.
METHODS
We retrospectively reviewed patients who underwent laparoscopic POP surgery at our hospital between April 2017 and September 2021.
RESULTS
In total, 191 cases were included in the analysis. Ten patients (5.2%) had cul-de-sac obliteration. No difference in age (73 years vs. 72 years, P = 0.99), parity (2 vs. 2, P = 0.64), or body mass index (BMI) (25.7 kg/m vs. 24.7 kg/m, P = 0.34) was observed between the cul-de-sac obliteration and normal groups. No significant differences were observed in the rate of previous abdominal surgery (50.0% vs. 32.6%, P = 0.46), rate of POP - quantification system (POP-Q) ≥ 2 posterior prolapse (40.0% vs. 46.4%, P = 0.98), and effect of defecation symptoms on the prolapse quality of life (p-QOL) score (vaginal bulge emptying bowels: 2.5 vs. 3.5, P = 0.15; empty bowel feeling: 3 vs. 3, P = 0.72, constipation: 3.5 vs. 3, P = 0.58; straining to open bowels: 3.5 vs. 3, P = 0.82; empty bowels with fingers: 1 vs. 1, P = 0.55) between the cul-de-sac obliteration and normal groups. Multivariate analysis of risk factors for the cul-de-sac obliteration was performed for age, number of births, previous abdominal surgery, and presence of rectocele; however no significant risk factors were extracted.
CONCLUSION
Predicting cul-de-sac obliteration preoperatively in patients undergoing POP surgery based on age, number of previous surgeries, previous abdominal surgeries, rectocele, and defecation symptoms is difficult.
Topics: Humans; Female; Retrospective Studies; Pelvic Organ Prolapse; Aged; Laparoscopy; Middle Aged; Douglas' Pouch; Quality of Life; Postoperative Complications; Gynecologic Surgical Procedures
PubMed: 38584245
DOI: 10.1007/s00404-024-07476-4 -
Cureus Dec 2023Pelvic floor dysfunction (PFD) is frequently reported in both sexes. Dynamic magnetic resonance defecography (DMRD) is the preferred modality, mainly due to its...
BACKGROUND
Pelvic floor dysfunction (PFD) is frequently reported in both sexes. Dynamic magnetic resonance defecography (DMRD) is the preferred modality, mainly due to its superiority and complementary role in clinical examination. However, studies from the perspective of Indian patients are scarce and mostly restricted to females. Thus, we assessed the diagnostic performance of DMRD in patients with PFD and correlated the findings with those on clinical examination.
MATERIALS AND METHODS
This prospective, observational study involved 57 adult patients of either sex, presenting with pelvic floor symptoms (PFS) and diagnosed with PFD. Initially, the patients underwent clinical examination, and diagnosis was recorded. Subsequently, the patients were subjected to DMRD. The findings were correlated with the Pearson "r" correlation coefficient.
RESULTS
A significantly greater proportion of patients had involvement of multiple compartments (36 vs. 12, p<0.001), cystocele (23 vs. 8, p=0.002), and rectal prolapse (25 vs. 14, p=0.030) on DMRD than clinical examination, while there was no significant difference regarding uterine prolapse (p=0.789). Grading of cystocele and rectal prolapse as well as diagnosis of enterocele/peritoneocele, rectocele, and intussusception could be done only with DMRD. DMRD had a strong and significant correlation with clinical examination regarding cystocele (r=0.943, p=0.003), uterine prolapse (r=0.972, p=0.001), and rectal prolapse (r=0.951, p=0.001).
CONCLUSIONS
DMRD demonstrated significantly better performance in the diagnosis of multiple compartment involvement, cystocele, and rectal prolapse. DMRD and clinical examination were significantly correlated regarding the diagnosis of cystocele, uterine prolapse, and rectal prolapse. Thus, DMRD provides information, in addition to the clinical examination, and should be used in symptomatic patients.
PubMed: 38292993
DOI: 10.7759/cureus.51378