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Polish Journal of Radiology 2022Dyssynergic defecation (DD) is defined as paradoxical contraction or inadequate relaxation of the pelvic floor muscles during defecation, which causes functional... (Review)
Review
Dyssynergic defecation (DD) is defined as paradoxical contraction or inadequate relaxation of the pelvic floor muscles during defecation, which causes functional constipation. Along with the anal manometry and balloon expulsion tests, magnetic resonance (MR) defecography is widely used to diagnose or rule out pelvic dyssynergia. Besides the functional abnormality, structural pathologies like rectocele, rectal intussusception, or rectal prolapse accompanying DD can also be well demonstrated by MR defecography. This examination can be an uncomfortable experience for the patient, so the imaging method and the importance of patient cooperation must be explained in detail. The defecatory phase of the examination is indispensable for evaluation, and inadequate effort should be ruled out before diagnosing DD. MR defecography provides important data for the diagnosis of DD, but optimal imaging criteria should be applied. Further tests can be suggested if patient co-operation is not sufficient or MR defecography findings are irrelevant.
PubMed: 35505854
DOI: 10.5114/pjr.2022.114866 -
Contrast Media & Molecular Imaging 2022The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells...
The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells procedure). We collected and summarized the X-ray performance and then analyzed the results of 107 patients with defecatory dysfunction who underwent defecography from January 2020 to March 2021. Furthermore, the preoperative and 6-month postoperative defecography results and clinical symptoms of 25 patients who underwent rectal prolapse surgery (modified Wells procedure) were compared. Results showed that among the 107 patients with defecation dysfunction, women had worse defecography results than men ( < 0.01). A total of 25 patients successfully completed the surgery without complications such as infection and intestinal fistula and there was no recurrence at 12 months of follow-up. Compared with the preoperative results, anorectal angle during defecation, the depth of rectocele, and perineal descent were significantly improved after the surgery ( < 0.01). Moreover, the patient's feeling of obstructed defecation and incomplete defecation was significantly relieved compared to that before the procedure ( < 0.01). In conclusion, defecography can be used to diagnose rectal prolapse preoperatively and evaluate the surgical effect combined with clinical symptoms postoperatively, which provides a clinical reference.
Topics: Defecography; Female; Humans; Male; Rectal Prolapse; Rectocele
PubMed: 35480080
DOI: 10.1155/2022/2219330 -
Obstetrics & Gynecology Science May 2022This study aimed to evaluate the current surgical techniques for anterior and posterior vaginal wall prolapse repair in South Korea.
OBJECTIVE
This study aimed to evaluate the current surgical techniques for anterior and posterior vaginal wall prolapse repair in South Korea.
METHODS
A web-based questionnaire survey was sent to 780 members of the Korean Society of Obstetrics and Gynecology. The items assessed in the questionnaire were the demographic characteristics and current surgical techniques used for the correction of anterior and posterior vaginal wall prolapse.
RESULTS
The response rate was 16%. There were variations in the suture materials and methods used for anterior and posterior colporrhaphy. Most respondents used only rapid absorbable suture materials to plicate the fibromuscular layer and close the mucosal layer of the anterior and posterior vaginal wall. Simple interrupted sutures are the most popular suture method for both the fibromuscular and mucosal layers. Thirty-one and eleven percent of the respondents used mesh for surgical correction of anterior and posterior vaginal wall prolapse, respectively. Concomitant perineorrhaphy was routinely performed with posterior vaginal wall repair by 42% of the respondents, whereas 58% performed perineorrhaphy only in cases with perineal defects.
CONCLUSION
There is considerable diversity in the current surgical techniques for anterior and posterior vaginal wall prolapse repair in Korea. Further research is required to standardize the surgical techniques.
PubMed: 35340135
DOI: 10.5468/ogs.21352 -
Frontiers in Surgery 2022Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo...
Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure. the aim of our study is to review the literature about preoperative assessment, operative features and outcomes of the STARR technique for the treatment of ODS. We performed a systematic search of literature, between January 2008 and December 2020 and 24 studies were included in this review. The total number of patients treated with STARR procedure was 4,464. In conclusion STARR surgical procedure has been proven to be safe and effective in treating symptoms of ODS and improving patients Quality of Life (QoL) and should be taken in consideration in the context of a holistic and multi modal approach to this complex condition. International guidelines are needed in order to optimize the diagnostic and therapeutic process and to improve outcomes.
PubMed: 35237648
DOI: 10.3389/fsurg.2022.790287 -
World Journal of Clinical Cases Jan 2022Laparoscopic ventral mesh rectopexy (LVMR) continues to be a popular treatment option for rectal prolapse, obstructive defecation/faecal incontinence and rectoceles. In...
BACKGROUND
Laparoscopic ventral mesh rectopexy (LVMR) continues to be a popular treatment option for rectal prolapse, obstructive defecation/faecal incontinence and rectoceles. In recent years there have been concerns regarding the safety of mesh placements in the pelvis.
AIM
To assess the safety of the mesh and the outcome of the procedure.
METHODS
Eighty-six patients underwent LVMR with Permacol (Biological) mesh from 2012 to 2018 at University Hospital Wishaw. Forty were treated for obstructive defecation secondary to prolapse, rectocele or internal rectal intussusception, 38 for mixed symptoms obstructive defecation and incontinence, 5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence. Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo. The average review of their notes was 18.3 ± 4.2 mo.
RESULTS
The median Wexner scores for constipation pre-operatively and post-operatively were 14.5 [Interquartile range (IQR): 10.5-18.5] and 3 (IQR: 1-6), respectively, while the median Wexner score for faecal incontinence was 11 (IQR: 7-15) and 2 (IQR: 0-5), respectively ( 0.01). There were 4 (4.6%) recurrences, 2 cases that presented with erosion of a suture through the rectum and one with diskitis. No mesh complications or mortalities were recorded.
CONCLUSION
LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence, rectal prolapse, rectoceles and internal rectal prolapse/intussusception.
PubMed: 35127904
DOI: 10.12998/wjcc.v10.i3.891 -
Colorectal Disease : the Official... Jun 2022The aim of this work was to study the technical success and diagnostic capability of magnetic resonance defaecography (MRD) compared with video defaecography (VD).
AIM
The aim of this work was to study the technical success and diagnostic capability of magnetic resonance defaecography (MRD) compared with video defaecography (VD).
METHOD
Sixty four women with defaecation disorders underwent both MRD and x-ray VD over 1 year. The assessment by two radiologists in consensus was retrospective and blinded. The technical success of straining and evacuation was evaluated subjectively. The presence of enterocele, intussusception, rectocele and dyssynergic defaecation was analysed according to established criteria, with VD as the standard of reference.
RESULTS
It was found that 62/64 (96.9%) VD studies were technically fully diagnostic compared with 29/64 (45.3%) for MRD. The number of partially diagnostic studies was 1/64 (1.6%) for VD versus 21/64 (32.8%) for MRD, with 1/64 (1.6%) (VD) and 14/64 (21.9%) (MRD) being nondiagnostic. Thirty enteroceles were observed by VD compared with seven in MRD with moderate agreement (κ = 0.41). Altogether 53 intussusceptions were observed by VD compared with 27 by MRD with poor agreement (κ = -0.10 and κ = 0.02 in recto-rectal and recto-anal intussusception, respectively). Moderate agreement (κ = 0.47) was observed in diagnosing rectocele, with 47 cases by VD and 29 by MRD. Dyssynergic defaecation was observed in three patients by VD and in 11 patients by MRD, with slight agreement (κ = 0.14).
CONCLUSION
The technical success and diagnostic capabilities of VD are better than those of MRD. VD remains the method of choice in the imaging of defaecation disorders.
Topics: Constipation; Defecation; Defecography; Female; Hernia; Humans; Intussusception; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Rectocele; Retrospective Studies; X-Rays
PubMed: 35119795
DOI: 10.1111/codi.16081 -
The Pan African Medical Journal 2021Ectopic adrenal gland in the ovary is very rare case, and even more rarer in older women. We reported a case of ectopic adrenal tissue as an incidental finding in left...
Ectopic adrenal gland in the ovary is very rare case, and even more rarer in older women. We reported a case of ectopic adrenal tissue as an incidental finding in left ovary from a 68-year-old woman. She presented with bearing down sensation due to uterine prolapse for 5 years. Upon physical examination, uterine prolapse grade III, cystocele, and rectocele were observed. Ultrasonography findings showed 0.69 cm intramural myoma, and no specific findings were found in the bilateral adnexae. She underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and anterior-posterior repair. The final pathologic diagnosis of the case was ectopic adrenal gland tissue in the left ovary and uterine leiomyoma. No eventful reactions were observed during hospitalization and after discharge. Although ectopic adrenal gland rarely occurs in elderly women and in the pelvic ovaries, it has a risk of neoplastic transformation and accompanying germ cell tumor and sex cord tumor. Hence, if the ectopic adrenal gland tissue is suspected during surgery, the tissue should be removed. Additionally, by closely examining the contralateral ovary, determining whether other lesions are suspected is necessary. If the other lesions including germ cell tumor or sex cord tumor are suspected, a biopsy of the contralateral ovarian tissue should be performed. Thus, gynecologists must have knowledge about ectopic adrenal gland tissues.
Topics: Adrenal Glands; Aged; Female; Humans; Hysterectomy; Leiomyoma; Ovary; Salpingo-oophorectomy
PubMed: 35059101
DOI: 10.11604/pamj.2021.40.181.31064 -
The Australian & New Zealand Journal of... Jun 2022Pregnancy and childbirth are thought to be the strongest environmental risk factors for pelvic organ prolapse, but prolapse does occur in nulliparae.
BACKGROUND
Pregnancy and childbirth are thought to be the strongest environmental risk factors for pelvic organ prolapse, but prolapse does occur in nulliparae.
AIM
To characterise prolapse in vaginal nulliparae.
MATERIAL AND METHODS
This was a retrospective study using archived clinical and imaging data of 368 vaginally nulliparous women seen between 2006 and 2017 at two tertiary urogynaecological centres. Patients underwent a standardised interview, clinical examination and 3D/4D translabial ultrasound. Volume datasets were analysed by the second author, blinded against all clinical data, using post-processing software on a personal computer. Significant prolapse was defined as Pelvic Organ Prolapse Quantification system stage ≥2 for the anterior and posterior compartment, and stage ≥1 for the central compartment. On imaging, significant prolapse was defined as previously described.
RESULTS
Of 4297 women seen during the inclusion period, 409 were vaginally nulliparous, for whom 368 volume data sets could be retrieved. Mean age was 50 years (17-89) and mean body mass index 29 (16-64). Eighty-one (22%) presented with prolapse symptoms. On clinical examination, 106 women (29%) had significant prolapse, mostly of the posterior compartment (n = 70, 19%). On imaging 64 women showed evidence of significant prolapse (17%), again mostly posterior (n = 47, 13%). Rectovaginal septal defects were even more common in 69 (19%). On multivariate analysis we found no differences between true nulliparae (n = 184) and women delivered exclusively by caesarean section (n = 184).
CONCLUSIONS
Prolapse occurs in vaginal nulliparae, but it has distinct characteristics. Rectocele predominates, while cystocele and uterine prolapse are uncommon. Pregnancy and caesarean delivery seem to have little effect.
Topics: Cesarean Section; Cystocele; Female; Humans; Middle Aged; Pelvic Floor; Pelvic Organ Prolapse; Pregnancy; Retrospective Studies; Ultrasonography
PubMed: 35048356
DOI: 10.1111/ajo.13481 -
Annals of Coloproctology Feb 2022
PubMed: 34839624
DOI: 10.3393/ac.2021.00892.0127 -
Gastroenterology Report Oct 2021Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography...
BACKGROUND
Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory. This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.
METHODS
In this pilot study, participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019. All participants separately underwent defecation proctography at sitting and squatting positions, and undertook transperineal ultrasonography at left lateral, sitting, and squatting positions. The consistency of ultrasonography and defecography was evaluated.
RESULTS
Thirty female volunteers with rectocele were included in this study. The degree of anorectal angle was significantly larger at rest and during contraction, maximal Valsalva, and evacuation; the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation; and the length of the perineum descending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography. The degree of anorectal angle, the depth of rectocele, the area of levator hiatus, and the volume of the rectocele were significantly different in using squatting, sitting, and left lateral positions when performing the transperineal ultrasonography. Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.
CONCLUSIONS
The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.
PubMed: 34733532
DOI: 10.1093/gastro/goab019