nach oben

International Urogynecology Journal

Erschienen in:

28.03.2022 | Original Article

The impact of transvaginal, mesh-augmented level one apical repair on anorectal dysfunction due to pelvic organ prolapse

verfasst von: M. Himmler, K. Göttl, M. Witczak, A. Yassouridis, D. M. Gold, B. Liedl

Erschienen in: International Urogynecology Journal | Ausgabe 11/2022

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

The objective was to investigate the symptom prevalence of anorectal dysfunction (AD) in women with pelvic organ prolapse (POP) and whether symptom improvement can be achieved by pelvic floor surgery.

Methods

Secondary analysis of the Propel Study data from 277 women with POP stage II–IV regarding bothersome AD symptoms, which were assessed using the Pelvic Floor Distress Inventory (PFDI) questionnaire preoperatively, and 6, 12, and 24 months after transvaginal prolapse repair with Elevate anterior and posterior.

Results

Prevalence of AD was high in the study cohort (14.4–56.3%) and could be reduced significantly throughout a 2-year follow-up (cure rates 44.3–83.1%). AD symptoms decreased in a similar manner after posterior/apical fixation to the way they did after anterior/apical fixation (e.g., feeling of incomplete bowel emptying 66.7% to 25.5% vs 46.5% to 10.7% respectively). Hemorrhoids and loss of loose stool decreased even more after anterior/apical fixation than after posterior/apical fixation. Even though AD symptoms decreased significantly more in patients with POP stage III–IV, there was still a considerable improvement in patients with POP stage II (e.g., pain when passing stool 31.1 to 7.7% vs 21.4 to 0% respectively). Notably, even symptoms of hemorrhoids and rectal prolapse improved substantially (cure rates 44.2% and 70.1% respectively).

Conclusions

Symptoms of AD were frequent in our study cohort, and they significantly improved after vaginal mesh-augmented sacrospinous prolapse repair with Elevate anterior and posterior throughout the follow-up period. Anterior/apical fixation showed results that were almost as good as those after posterior/apical fixation. Patients with POP stage II experienced considerable symptom improvement, but cure rates were significantly higher in patients with POP stage III–IV.

Brief summary

Vaginal mesh-augmented prolapse repair with good apical fixation is efficacious in resolving AD symptoms with low de novo rates in women suffering of POP.

Nur mit Berechtigung zugänglich

Liedl B, Goeschen K, Durner L. Current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder and bowel dysfunction. Curr Opin Urol. 2017;27(3):274–81. https://doi.org/10.1097/MOU.0000000000000395.CrossRefPubMed

Bradley CS, Brown MB, Cundiff GW, et al. Bowel symptoms in women planning surgery for pelvic organ prolapse. Am J Obstet Gynecol. 2006;195(6):1814–9. https://doi.org/10.1016/j.ajog.2006.07.008.CrossRefPubMed

Ha K, Dancz C, Nelken R, Contreras M, Ozel B. Colorectal and anal symptoms in women with urinary incontinence and pelvic organ prolapse. Int Urogynecol J. 2010;21(2):187–91. https://doi.org/10.1007/s00192-009-1008-5.CrossRefPubMed

Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006;130(5):1510–8. https://doi.org/10.1053/j.gastro.2005.11.064.CrossRefPubMed

Petros P, Swash M. The musculo-elastic theory for anorectal function and dysfunction. Pelviperineology. 2008;27:89–93.

Gordon AM, Huxley AF, Julian FJ. The variation in isometric tension with sarcomere length in vertebrate muscle fibres. J Physiol. 1966;184(1):170–92. https://doi.org/10.1113/jphysiol.1966.sp007909.CrossRefPubMedPubMedCentral

Clinicaltrials. https://clinicaltrials.gov/ct2/show/study/NCT00638235?cond=NCT00638235&rank=1. Accessed 23 Nov 2021

Azaïs H, Charles CJ, Delporte P, Debodinance P. Prolapse repair using the Elevate™ kit: prospective study on 70 patients. Int Urogynecol J. 2012;23(10):1421–8. https://doi.org/10.1007/s00192-012-1673-7.CrossRefPubMed

Vierhout ME, Withagen MI, Futterer JJ. Rectal obstruction after a vaginal posterior compartment polypropylene mesh fixed to the sacrospinous ligaments. Int Urogynecol J. 2011;22(8):1035–7. https://doi.org/10.1007/s00192-011-1376-5.CrossRefPubMedPubMedCentral

10.

Hocking I. Double incontinence, urinary and fecal, cured by surgical reinforcement of the pubourethral ligaments. Pelviperineology. 2008;27:110.

11.

Petros P, Richardson P. Fecal incontinence cure by surgical reinforcement of the pelvic ligaments suggests a connective tissue aetiology. Pelviperineology. 2008;27:111–3.

12.

Abendstein B, Petros P, Richardson P. Ligamentous repair using the tissue fixation system confirms a causal link between damaged suspensory ligaments and urinary and fecal incontinence. Pelviperineology. 2008;27:114–7.

13.

Abendstein B, Brugger C, Furtschegger A. Role of the uterosacral ligaments in the causation of rectal intussusception, abnormal bowel emptying, and fecal incontinence. A prospective study. Pelviperineology. 2008;27:118–21.

14.

Ramanah R, Ballester M, Chereau E, Bui C, Rouzier R, Darai E. Anorectal symptoms before and after laparoscopic sacrocolpoperineopexy for pelvic organ prolapse. Int Urogynecol J. 2012;23(6):779–83. https://doi.org/10.1007/s00192-011-1657-z.CrossRefPubMed

15.

Fox SD, Stanton SL. Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition. BJOG. 2000;107(11):1371–5.CrossRef

16.

Claerhout F, De Ridder D, Roovers JP, et al. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009;55(6):1459–67. https://doi.org/10.1016/j.eururo.2008.12.008.CrossRefPubMed

17.

Bradley CS, Nygaard IE, Brown MB, et al. Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol. 2007;197(6):642.e1–8. https://doi.org/10.1016/j.ajog.2007.08.023.CrossRef

18.

Miedel A, Tegerstedt G, Morlin B, Hammarstrom M. A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1593–601. https://doi.org/10.1007/s00192-008-0702-z.CrossRefPubMed

19.

Sung VW, Rardin CR, Raker CA, LaSala CA, Myers DL. Changes in bowel symptoms 1 year after rectocele repair. Am J Obstet Gynecol. 2012;207(5):423 e421–5. https://doi.org/10.1016/j.ajog.2012.06.054.CrossRef

20.

Farid M, Madbouly KM, Hussein A, Mahdy T, Moneim HA, Omar W. Randomized controlled trial between perineal and anal repairs of rectocele in obstructed defecation. World J Surg. 2010;34(4):822–9. https://doi.org/10.1007/s00268-010-0390-y.CrossRefPubMed

21.

Gustilo-Ashby AM, Paraiso MF, Jelovsek JE, Walters MD, Barber MD. Bowel symptoms 1 year after surgery for prolapse: further analysis of a randomized trial of rectocele repair. Am J Obstet Gynecol. 2007;197(1):76.e1–5. https://doi.org/10.1016/j.ajog.2007.02.045.CrossRef

22.

Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol. 1997;104(1):82–6.CrossRef

23.

Dua A, Radley S, Brown S, Jha S, Jones G. The effect of posterior colporrhaphy on anorectal function. Int Urogynecol J. 2012;23(6):749–53. https://doi.org/10.1007/s00192-011-1603-0.CrossRefPubMed

24.

Abramov Y, Gandhi S, Goldberg RP, Botros SM, Kwon C, Sand PK. Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol. 2005;105(2):314–8. https://doi.org/10.1097/01.AOG.0000151990.08019.30.CrossRefPubMed

25.

Gutman RE, Bradley CS, Ye W, et al. Effects of colpocleisis on bowel symptoms among women with severe pelvic organ prolapse. Int Urogynecol J. 2010;21(4):461–6. https://doi.org/10.1007/s00192-009-1062-z.CrossRefPubMed

26.

Paradisi G, Petros P. Cure of haemorrhoids following a TFS posterior sling and TFS perineal body repair—a case report. Pelviperineology. 2010;29:62–3.

Titel: The impact of transvaginal, mesh-augmented level one apical repair on anorectal dysfunction due to pelvic organ prolapse
verfasst von: M. Himmler
K. Göttl
M. Witczak
A. Yassouridis
D. M. Gold
B. Liedl
Publikationsdatum: 28.03.2022
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 11/2022
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-022-05151-3

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

28.05.2024 Kinder- und Jugendgynäkologie Nachrichten

Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

26.05.2024 Mammakarzinom Nachrichten

Frauen, die zum Zeitpunkt der Brustkrebsdiagnose eine hohe mammografische Brustdichte aufweisen, haben ein erhöhtes Risiko für ein baldiges Rezidiv, legen neue Daten nahe.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

The impact of transvaginal, mesh-augmented level one apical repair on anorectal dysfunction due to pelvic organ prolapse

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Brief summary

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Fehlerkultur in der Medizin – Offenheit zählt!

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

Update Gynäkologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Brief summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2022

Technical features, perioperative and anatomical outcomes of a standardized suturing pattern for robotic sacrocolpopexy

Thai translation and validation of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) and Pelvic Floor Distress Inventory (PFDI-20)

Medium term anatomical and functional outcomes following modified laparoscopic sacrocolpopexy

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Female Sexual Distress Scale-Revised questionnaire for women with vaginal laxity

Obstructed defecation syndrome in the first week after pelvic reconstructive surgery

Anatomical and functional outcomes of non-obstetric urogenital fistula repair

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Fehlerkultur in der Medizin – Offenheit zählt!

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

Update Gynäkologie