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01-09-2019 | Dyspareunia | Original Article

Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations

Authors: Cara L. Grimes, Megan O. Schimpf, Cecilia K. Wieslander, Ambereen Sleemi, Paula Doyle, You (Maria) Wu, Ruchira Singh, Ethan M. Balk, David D. Rahn, for the Society of Gynecologic Surgeons (SGS) Systematic Review Group (SRG)

Published in: International Urogynecology Journal | Issue 9/2019

Abstract

Introduction and hypothesis

Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both conditions among different surgical approaches.

Methods

A systematic review was performed comparing the impact of surgical interventions in the posterior compartment on prolapse and defecatory symptoms. MEDLINE, Embase, and ClinicalTrials.gov were searched from inception to 4 April 2018. Randomized controlled trials, prospective and retrospective comparative and single-group studies of women undergoing posterior vaginal compartment surgery for vaginal bulge or bowel symptoms were included. Studies had to include both anatomical and symptom outcomes both pre- and post-surgery.

Results

Forty-six eligible studies reported on six surgery types. Prolapse and defecatory symptoms improved with native-tissue transvaginal rectocele repair, transanal rectocele repair, and stapled transanal rectocele repair (STARR) surgeries. Although prolapse was improved with sacrocolpoperineopexy, defecatory symptoms worsened. STARR caused high rates of fecal urgency postoperatively, but this symptom typically resolved with time. Site-specific posterior repairs improved prolapse stage and symptoms of obstructed defecation. Compared with the transanal route, native-tissue transvaginal repair resulted in greater improvement in anatomical outcomes, improved obstructed defecation symptoms, and lower chances of rectal injury, but higher rates of dyspareunia.

Conclusions

Surgery in the posterior vaginal compartment typically has a high rate of success for anatomical outcomes, obstructed defecation, and bulge symptoms, although these may not persist over time. Based on this evidence, to improve anatomical and symptomatic outcomes, a native-tissue transvaginal rectocele repair should be preferentially performed.

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Title: Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations
Authors: Cara L. Grimes
Megan O. Schimpf
Cecilia K. Wieslander
Ambereen Sleemi
Paula Doyle
You (Maria) Wu
Ruchira Singh
Ethan M. Balk
David D. Rahn
for the Society of Gynecologic Surgeons (SGS) Systematic Review Group (SRG)
Publication date: 01-09-2019
Publisher: Springer International Publishing
Keywords: Dyspareunia
Rectocele
Published in: International Urogynecology Journal / Issue 9/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04001-z

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Springer Medicine

Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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