Top

Published in:

01-12-2016 | Original Article

Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy

Authors: Cara L. Grimes, Rosanna H. Overholser, Ronghui Xu, Jasmine Tan-Kim, Charles W. Nager, Keisha Y. Dyer, Shawn A. Menefee, Gouri B. Diwadkar, Emily S. Lukacz

Published in: International Urogynecology Journal | Issue 12/2016

Abstract

Introduction and hypothesis

We hypothesized that there would be a significant difference in changes in obstructed defecation symptoms and posterior compartment prolapse between women who underwent posterior vaginal wall prolapse repair (PR) and those who did not.

Methods

This was a two-site prospective cohort study of women undergoing prolapse or incontinence surgery in which a PR was, or was not, performed at the discretion of the surgeon. Women were assessed using validated obstructed defecation questionnaires and standardized examination measures (including POP-Q, measurement of transverse gh, and assessment for a rectovaginal pocket and laxity) prior to pelvic surgery and 12 weeks after surgery.

Results

Of 68 women who underwent surgery, 43 had PR. The PR group had higher obstructed defecation symptoms and greater posterior compartment prolapse at baseline. At 12 weeks, obstructed defecation symptoms had improved significantly more in the PR group than in the no PR group (all p < 0.03). Anatomic outcomes showed greater improvement in point Bp in the PR group (−3.4 vs. −0.7 no PR, p < 0.001) and resolution of the rectovaginal pocket (86 % vs. 42 %, p = 0.002). There were no significant changes in obstructed defecation symptoms or anatomic outcomes from baseline in the no PR group, while the PR group showed significantly improved obstructed defecation symptoms and anatomic outcomes after repair (p < 0.001 for both).

Conclusions

Significant improvements in obstructed defecation symptoms and posterior compartment prolapse were seen after PR, but not in women who did not receive PR. Obstructed defecation symptoms, Bp and rectovaginal pocket were the measures best able to demonstrate improvement after PR. We recommend the use of these measures to assess the impact of surgery in the posterior compartment.

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166CrossRefPubMed

Handa VL, Garrett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 190(1):27–32CrossRefPubMed

Cundiff GW, Fenner D (2004) Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol 104(6):1403–1421CrossRefPubMed

Grimes CL, Tan-Kim J, Nager CW et al (2014) Outcome measures to assess anatomy and function of the posterior vaginal compartment. Int Urogynecol J 25(7):893–899CrossRefPubMed

Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113CrossRefPubMed

Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10(1):84–88

Lewis SJ, Heaton KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32(9):920–924CrossRefPubMed

Bradley CS, Brown MB, Cundiff GW et al (2006) Bowel symptoms in women planning surgery for pelvic organ prolapse. Am J Obstet Gynecol 195(6):1814–1819CrossRefPubMed

Dua A, Radley S, Brown S, Jha S, Jones G (2012) The effect of posterior colporrhaphy on anorectal function. Int Urogynecol J 23(6):749–753CrossRefPubMed

10.

Gustilo-Ashby AM, Paraiso MF, Jelovsek JE, Walters MD, Barber MD (2007) Bowel symptoms 1 year after surgery for prolapse: further analysis of a randomized trial of rectocele repair. Am J Obstet Gynecol 197(1):76.e1–76.e5CrossRef

11.

Abramov Y, Gandhi S, Goldberg RP, Botros SM, Kwon C, Sand PK (2005) Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol 105(2):314–318CrossRefPubMed

12.

Sloots CE, Meulen AJ, Felt-Bersma RJ (2003) Rectocele repair improves evacuation and prolapse complaints independent of anorectal function and colonic transit time. Int J Colorectal Dis 18(4):342–348PubMed

13.

Porter WE, Steele A, Walsh P, Kohli N, Karram MM (1999) The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol 181(6):1353–1358, discussion 1358–9CrossRefPubMed

14.

Polin MR, Gleason JL, Szychowski JM, Holley RL, Richter HE (2012) Effects of transvaginal repair of symptomatic rectocele on symptom specific distress and impact on quality of life. J Gynaecol Obstet 117(3):224–227

15.

Kahn MA, Stanton SL (1997) Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 104(1):82–86

16.

Grimes CL, Lukacz ES, Gantz MG et al (2014) What happens to the posterior compartment and bowel symptoms after sacrocolpopexy? Evaluation of 5-year outcomes from E-CARE. Female Pelvic Med Reconstr Surg 20(5):261–266CrossRefPubMedPubMedCentral

17.

Kaser DJ, Kinsler EL, Mackenzie TA, Hanissian P, Strohbehn K, Whiteside JL (2012) Anatomic and functional outcomes of sacrocolpopexy with or without posterior colporrhaphy. Int Urogynecol J 23(9):1215–1220CrossRefPubMed

Title: Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy
Authors: Cara L. Grimes
Rosanna H. Overholser
Ronghui Xu
Jasmine Tan-Kim
Charles W. Nager
Keisha Y. Dyer
Shawn A. Menefee
Gouri B. Diwadkar
Emily S. Lukacz
Publication date: 01-12-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 12/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-016-3046-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2016

Does the diagnosis of detrusor overactivity affect the long-term prognosis of patients treated with a retropubic midurethral sling?

A retrospective comparison of two vaginal mesh kits in the management of anterior and apical vaginal prolapse: long-term results for apical fixation and quality of life

Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion

Female pelvic organ prolapse using pessaries: systematic review

Analysis of changes in sexual function in women undergoing pelvic organ prolapse repair with abdominal or vaginal approaches

Can pelvic floor dysfunction after vaginal birth be prevented?