Does the presence of a true radiological rectocele increase the likelihood of symptoms of prolapse?
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ORIGINAL ARTICLE
Does the presence of a true radiological rectocele increase the likelihood of symptoms of prolapse? H. P. Dietz 1
&
B. Brown 2 & T. Friedman 3 & N. Subramaniam 2
Received: 27 May 2020 / Accepted: 27 July 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Posterior compartment prolapse is commonly due to a ‘true’ rectocele, i.e., a diverticulum of the rectal ampulla. This condition is associated with symptoms of obstructed defecation and may contribute to prolapse symptoms. We tested the hypothesis: ‘A true rectocele is an independent predictor of symptoms of prolapse.’ Methods This was a retrospective cohort study of patients presenting to a urogynecology unit for symptoms of pelvic floor dysfunction between September 2011 and June 2016. Assessment included a structured interview, POP-Q examination and 4D TLUS. Ultrasound volume data were acquired on Valsalva. Offline measurements were performed by analysis of stored volume data sets at a later date, blinded to all clinical data. Results One hundred six patients were excluded because of incomplete data. Of the remainder, Bp was the most distal point on POP-Q in 348. Statistical analysis was performed on this cohort. Mean age was 60 (33–86) years and mean BMI 31 (18–55) kg/ m². One hundred fifty-three patients (44%) presented with symptoms of prolapse; 272 were diagnosed with a true rectocele on TLUS. Bp on POP-Q and true rectocele on TLUS were both significantly associated with prolapse symptoms; however, on multivariate analysis the latter became nonsignificant (p = 0.059). Receiver-operating characteristic (ROC) analysis confirmed that the presence of a true rectocele on TLUS did not contribute significantly to symptoms of prolapse (AUC 0.66 for model with rectocele, AUC 0.65 without). Conclusions The presence of a true rectocele on TLUS does not seem to contribute substantially to the manifestation of clinical symptoms of prolapse. Keywords Pelvic organ prolapse . Rectocele . Translabial ultrasound
Introduction Posterior compartment prolapse may be due to a number of different anatomical entities [1]. A similar degree of posterior compartment descent may be caused by a true rectocele, that is, Presentation at Meetings: The abstract was presented at IUGA 2017, Vancouver * H. P. Dietz [email protected] 1
Department of Obstetrics, Gynecology & Neonatology Sydney Medical School Nepean, The University of Sydney, 62 Derby Street, Kingswood, NSW 2747, Australia
2
University of Sydney, Penrith, Australia
3
Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
a diverticulum of the rectal ampulla [2], a hypermobile perineum, an enterocele, a recto-enterocele or even a rectal intusussception [3]. Contrast defecography, MRI and translabial ultrasound (TLUS) can all be used to differentiate between these different anatomical conditions [4–6]. A ‘true rectocele’ is considered a defect of the rectovaginal septum [7], an interpretation that is supported by pre- and postoperati
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