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Lower Urinary Tract Symptoms Jul 2023To present the anatomic outcomes of sacrohysteropexy surgery without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles.
OBJECTIVES
To present the anatomic outcomes of sacrohysteropexy surgery without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles.
METHODS
The patients who underwent abdominal sacrohysteropexy without posterior mesh placement for the treatment of symptomatic grade 3 and 4 anterior/apical prolapse + asymptomatic grade 1 and 2 rectocele between May 2015 and January 2021 were evaluated retrospectively. The success rate, the anatomic outcomes (for anterior, apical, and posterior pelvic organ prolapse [POP]), and perioperative data of the surgical procedure were assessed. The objective failure criteria after surgery included the presence of grade 1 or higher in any compartment (anatomical criteria), recurrent POP requiring an operation, and/or usage of pessaries. Perioperative adverse events were categorized according to the Clavien-Dindo classification.
RESULTS
Fifty-one patients underwent sacrohysteropexy without posterior mesh. The mean age of the patients was 56.8 ± 10 years. The success rates (anatomical outcomes) for the anterior/apical and posterior POP in the study group were 60.7%, 54.9%, and 58.8%, respectively, at a median follow-up time of 40.24 (24-71) months. The median hospital stay was 3.1 (2-6) days. The mean estimated blood loss was 127.6 (80-150) mL. The mean operation time was 114 (90-156) min. The mean urethral and catheter removal times were 1.3 (1, 2) and 2.1 (2-4) days, respectively. The mean recovery time of gastrointestinal motility was 14.4 h (11-35).
CONCLUSIONS
Sacrohysteropexy without posterior mesh placement might be associated with less pain, shorter operative time, and shorter recovery time of gastrointestinal motility, without compromising the anatomic success.
Topics: Female; Humans; Middle Aged; Aged; Rectocele; Surgical Mesh; Retrospective Studies; Treatment Outcome; Uterus; Pelvic Organ Prolapse
PubMed: 36994630
DOI: 10.1111/luts.12479 -
Neurogastroenterology and Motility Aug 2023Patients with obstructed defecatory symptoms (ODS) are commonly referred to either gastroenterologists (GE) or colorectal surgeons (CS). Further management of these...
BACKGROUND
Patients with obstructed defecatory symptoms (ODS) are commonly referred to either gastroenterologists (GE) or colorectal surgeons (CS). Further management of these patients may be impacted by this choice of referral.
METHODS
An online survey of specialist practice was disseminated to GE and CS in Australia and New Zealand. A case vignette of a patient presenting with ODS was described, with multiple subsequent scenarios designed to delineate the responder's preferred approach to management of this patient.
KEY RESULTS
A total of 107 responders participated in the study, 62 CS and 45 GE. For a female patient with ODS not responding to pharmacological treatment, GE were more likely than CS to refer patients for anorectal manometry, while CS were more likely to refer for dynamic imaging. A quarter of CS and GE referred patients directly to pelvic floor physiotherapy, without any pre-treatment testing. Knowing the result of dynamic imaging, especially if a rectocele was demonstrated, substantially influenced management for both of the specialties: GE became more likely to refer the patients for CS consultation and less likely to refer directly for biofeedback or physiotherapy and CS were more likely to opt for an operative pathway over conservative management than they were prior to knowledge of the imaging findings. The majority (>75%) of GE and CS did not find it necessary to obtain a gynecological consultation, even in the presence of a rectocele.
CONCLUSIONS & INFERENCES
Practice variation across medical specialties affects diagnostic and management recommendations for patients with ODS, impacting treatment pathways. Our findings provide an incentive toward establishing interdisciplinary, uniform, management guidelines.
Topics: Humans; Female; Rectocele; Constipation; Anal Canal; Defecography; Surgeons; Defecation
PubMed: 37036403
DOI: 10.1111/nmo.14592 -
Medicina (Kaunas, Lithuania) May 2024: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with the neuromuscular structure of the vagina in...
Evaluation of Neuromuscular Morphometry of the Vaginal Wall Using Protein Gene Product 9.5 (Pgp 9.5) and Smooth Muscle α-Actin (Sma) in Patients with Posterior Vaginal Wall Prolapse.
: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with the neuromuscular structure of the vagina in women without prolapse, to determine the difference, and to demonstrate the role of neuromuscular structure in the physiopathology of prolapse. : In this prospective study, women aged between 40 and 75 years who had not undergone any vaginal surgery and had not undergone any abdominal prolapse surgery were included. Thirty-one women diagnosed with rectocele on examination were included in the study group. Thirty-one patients who underwent vaginal intervention and hysterectomy for reasons other than rectocele (colposcopy, conization, etc.) without anterior or posterior wall prolapse were included in the control group. Biopsy material was obtained from the epithelium of the posterior wall of the vagina, including the fascia that fits the Ap point. Immunohistochemical staining with Protein Gene Product 9.5 and smooth muscle α-actin was performed in the pathology laboratory. The epithelial thickness measurement and smooth muscle density parameters obtained with these immunohistochemical stainings were compared between the two groups. The collected data were analyzed using the SPSS 23 package program. values less than 0.05 were considered statistically significant. : In the control group, muscle thickness and the number of nerves per mm of fascia were statistically significantly higher than in the study group ( < 0.05). : We found that smooth muscle tissue and the number of nerves per mm of fascia were decreased in posterior vaginal wall prolapse compared to the general population. Based on the correlation coefficients, age was the parameter that most affected the degree of prolapse, followed by parity, number of live births, and number of vaginal deliveries.
Topics: Humans; Female; Middle Aged; Vagina; Adult; Prospective Studies; Aged; Actins; Uterine Prolapse; Muscle, Smooth; Immunohistochemistry; Ubiquitin Thiolesterase
PubMed: 38792998
DOI: 10.3390/medicina60050816 -
Journal of Ultrasound in Medicine :... May 2024The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that...
OBJECTIVES
The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP.
METHODS
Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM.
RESULTS
A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P: .012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P: .03) and the middle third of the anorectal canal (P: .019).
CONCLUSION
It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP.
Topics: Female; Humans; Elasticity; Elasticity Imaging Techniques; Pelvic Floor; Pelvic Organ Prolapse; Pilot Projects; Prospective Studies; Uterine Prolapse; Vagina
PubMed: 38284137
DOI: 10.1002/jum.16422 -
BMC Surgery Nov 2023Obstructed defecation syndrome represents 50-60% of patients with symptoms of constipation. We aimed to compare the two frequently performed surgical methods,...
Laparoscopic ventral mesh rectopexy vs. transperineal mesh repair for obstructed defecation syndrome associated with rectocele: comparison of selectively distributed patients.
PURPOSE
Obstructed defecation syndrome represents 50-60% of patients with symptoms of constipation. We aimed to compare the two frequently performed surgical methods, laparoscopic ventral mesh rectopexy and transperineal mesh repair, for this condition in terms of functional and surgical outcomes.
METHODS
This study is a retrospective review of 131 female patients who were diagnosed with obstructed defecation syndrome, attributed to rectocele with or without rectal intussusception, enterocele, hysterocele or cystocele, and who underwent either laparoscopic ventral mesh rectopexy or transperineal mesh repair. Patients were evaluated for surgical outcomes based on the operative time, the length of hospital stay, operative complications, using prospectively designed charts. Functional outcome was assessed by using the Initial Measurement of Patient-Reported Pelvic Floor Complaints Tool.
RESULTS
Fifty-one patients diagnosed with complex rectocele underwent laparoscopic ventral mesh rectopexy, and 80 patients diagnosed with simple rectocele underwent transperineal mesh repair. Mean age was found to be 50.35 ± 13.51 years, and mean parity 2.14 ± 1.47. Obstructed defecation symptoms significantly improved in both study groups, as measured by the Colorectal Anal Distress Inventory, Constipation Severity Instrument and Patient Assessment of Constipation-Symptoms scores. Minor postoperative complications including wound dehiscence (n = 3) and wound infection (n = 2) occurred in the transperineal mesh repair group.
CONCLUSION
Laparoscopic ventral mesh rectopexy and transperineal mesh repair are efficient and comparable techniques in terms of improvement in constipation symptoms related to obstructed defecation syndrome. A selective distribution of patients with or without multicompartmental prolapse to one of the treatment arms might be the preferred strategy.
Topics: Humans; Female; Adult; Middle Aged; Rectocele; Defecation; Rectal Prolapse; Surgical Mesh; Treatment Outcome; Follow-Up Studies; Laparoscopy; Constipation; Hernia; Rectum
PubMed: 38001430
DOI: 10.1186/s12893-023-02206-0 -
Cureus Sep 2023Vaginal cysts are often encountered in gynaecological outpatient settings. These are usually asymptomatic in their initial course but become symptomatic when their size...
Vaginal cysts are often encountered in gynaecological outpatient settings. These are usually asymptomatic in their initial course but become symptomatic when their size increases or they get infected. While evaluating such cases, clinical examination plays a vital role in ruling out their differential diagnoses. Imaging studies can complement clinical findings. However, in some instances, the nature of vaginal cysts may not be determined preoperatively until histopathology examination reveals it. We report here a rare case of a posterior vaginal wall cyst that presented as a mass protruding through the vagina. The clinical dilemma was the characterization of the cyst, owing to its huge size and rare location. The cyst was managed surgically by excision, and to our surprise, histopathological examination revealed it as a Bartholin gland cyst in the posterior vaginal wall, rare in its location.
PubMed: 37868521
DOI: 10.7759/cureus.45607 -
The Pan African Medical Journal 2024pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her...
INTRODUCTION
pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her quality of life. This study aims to determine the epidemiological, clinical, and therapeutic profile of pelvic organ prolapse in the town of Kananga.
METHODS
this is a cross-sectional study of cases of pelvic organ prolapse recorded during the mass campaign organized in the Bon-Berger Hospital of Tshikaji and Saint Georges Hospital of Katoka in the town of Kananga, from January 1 to July 31, 2023. Non-probability convenience sampling was used to select cases.
RESULTS
we recorded 138 cases of prolapse out of 572 patients. The prevalence of pelvic organ prolapse is 24.12% with an average monthly incidence of 19.71 (SD: 4.23) cases per month. The prevalence of recurrence of pelvic organ prolapse is 8.69%. The average age of patients is 54.86 (SD: 11.36) years with an average parity of 7.62 (SD: 1.8) deliveries. Its preoperative symptomatology consists of the intravaginal mass associated with digestive and urinary disorders in 97.00% (n=130), stage III hysterocele predominates in 68.70% (n=92), surgical treatment is the most practiced in 91.79% (n=123) and hysterectomy associated with the treatment of cystocele and rectocele by vaginal surgical access is the most practiced in 80.60% (n=108).
CONCLUSION
pelvic organ prolapse is a real public health problem in the city of Kananga, its symptoms are classic and its treatment is surgical via the vaginal route.
Topics: Humans; Cross-Sectional Studies; Female; Democratic Republic of the Congo; Pelvic Organ Prolapse; Middle Aged; Adult; Prevalence; Aged; Incidence; Quality of Life; Recurrence; Young Adult
PubMed: 38646133
DOI: 10.11604/pamj.2024.47.52.42470 -
International Urogynecology Journal Aug 2023Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a...
INTRODUCTION AND HYPOTHESIS
Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse.
METHODS
Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively.
RESULTS
Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation.
CONCLUSIONS
Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication.
Topics: Humans; Female; Middle Aged; Aged; Uterine Prolapse; Surgical Mesh; Gynecologic Surgical Procedures; Pelvic Organ Prolapse; Treatment Outcome
PubMed: 36795111
DOI: 10.1007/s00192-023-05471-y -
Case Reports in Women's Health Jun 2024Pelvic organ prolapse (POP) is a very common problem that can affect any aspect of the pelvic floor. Often, vaginal and rectal prolapse occur simultaneously. Prior case...
Pelvic organ prolapse (POP) is a very common problem that can affect any aspect of the pelvic floor. Often, vaginal and rectal prolapse occur simultaneously. Prior case reports have suggested resolution of symptoms of rectal prolapse in those with concomitant rectal and vaginal prolapse; however, the overall body of evidence is limited. We present the cases of two patients who had complete resolution of their symptoms of rectal prolapse after repair of a concomitant vaginal prolapse. Both patients underwent a traditional rectocele repair and perineoplasty, and subsequently reported complete resolution of their symptoms of rectal prolapse, which persisted at their six-month post-operative visits. The second patient ultimately canceled a previously scheduled rectopexy with colorectal surgery. Perhaps a rectocele repair with perineoplasty is limiting rectal mobility, and therefore eliminating its ability to prolapse or intussuscept and cause bothersome symptoms. We suggest that those with concomitant vaginal and rectal prolapse desiring corrective surgery first undergo a less invasive vaginal repair. Post-operative re-evaluation of the symptoms rectal prolapse might then demonstrate that a more invasive rectal prolapse repair, which may involve a colon resection and prolonged hospital stay, was not in fact needed. Further prospective and randomized study is needed to determine the long-term outcomes of concomitant rectal and vaginal prolapse in those who first undergo a vaginal repair.
PubMed: 38596813
DOI: 10.1016/j.crwh.2024.e00606 -
BMC Gastroenterology Jan 2024Few studies have investigated healthy female individuals (HFI) and those with obstructed defecation syndrome associated with moderate rectocele in women (MRW),...
BACKGROUND
Few studies have investigated healthy female individuals (HFI) and those with obstructed defecation syndrome associated with moderate rectocele in women (MRW), identified using three-dimensional high-resolution anorectal manometry (3D HRAM) parameters that correlate with age stratification.
OBJECTIVE
We aimed to explore the clinical diagnostic values of the MRW and HFI groups using 3D HRAM parameters related to age stratification.
METHODS
A prospective non-randomized controlled trial involving 128 cases from the MRW (treatment group, 68 cases) and HFI (control group, 60 cases) groups was conducted using 3D HRAM parameters at Tianjin Union Medical Center between January 2017 and June 2022, and patients were divided into two subgroups based on their ages: the ≥50 and < 50 years subgroups.
RESULTS
Multivariate binary logistic regression analysis showed that age (P = 0.024) and rectoanal inhibitory reflex (P = 0.001) were independent factors affecting the disease in the MRW group. Compared to the HFI group, the receiver operating characteristic (ROC) curve demonstrated that the 3D HRAM parameters exhibited a higher diagnostic value for age (Youden index = 0.31), urge to defecate (Youden index = 0.24), and rectoanal pressure differential (Youden index = 0.21) in the MRW group.
CONCLUSIONS
Compared to the HFI group, the ROC curve of the 3D HRAM parameters suggests that age, urge to defecate, and rectoanal pressure differential in the MRW group have a significant diagnostic value. Because the Youden index is lower, 3D HRAM cannot be considered the gold standard method for diagnosing MRW.
Topics: Humans; Female; Middle Aged; Rectocele; Defecation; Anal Canal; Manometry; Prospective Studies; Syndrome; Constipation; Rectum
PubMed: 38178041
DOI: 10.1186/s12876-023-03063-0