Pelvic Organ Prolapse Suspension
It may seem strange for a coloproctologist to propose a new procedure for correcting genital prolapse and therefore it is necessary to relate the background to this initiative; however, this will be limited to the most relevant data. At the European Cente
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Antonio Longo, Brigitta Boller, Francesco Crafa, and Federico Perrone
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Background
It may seem strange for a coloproctologist to propose a new procedure for correcting genital prolapse and therefore it is necessary to relate the background to this initiative; however, this will be limited to the most relevant data. At the European Center of Coloproctology and Pelvic Diseases, Vienna, we examined about 1,000 women affected by disorders of evacuation between the years 1999 and 2001. The data we are interested in reporting in order to explain the technique relate to patients with genital prolapse or those who had already undergone surgery for this condition. Of 322 patients, who had previously undergone operations for genital prolapse, 306 (95%) had symptoms of obstructed defecation, with an average Longo obstructed defecation syndrome (ODS) score of 9.5 (range 4–36). Thirty-nine (12%) had impaired fecal incontinence (FI), with an average Wexner incontinence score of 4 (range 1–16) [1]. Only 12 patients (3.7%) had undergone defecography before surgery. A review of the literature shows that only 25% of publications reporting results after correction of genital prolapse, using any technique, quote the effects of the surgery on obstructed defecation and/or FI. Moreover very few studies use a score for ODS or FI preoperatively and postoperatively. This suggests that urogynecologists do not focus enough attention on the rectum and defecation disorders, and that coloproctologists have probably not gone into enough depth in investigating the association between urogenital prolapse and rectal prolapse. In 615 women with varying degrees of genital prolapse who requested examination at our center for ODS or active FI, dynamic pelvigraphy revealed an association between genital prolapse and internal or external rectal prolapse and/or rectocele in 100% of cases.
A. Longo () European Center of Coloproctology and Pelvic Diseases, Vienna, Austria e-mail: [email protected] A. L. Gaspari, P. Sileri (Eds), Pelvic Floor Disorders: Surgical Approach, Updates in Surgery DOI: 10.1007/978-88-470-5441-7_21, © Springer-Verlag Italia 2014
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A. Longo et al.
To determine whether this association is constant, or whether it affects only women with symptoms of obstructed defecation, in collaboration with gynecologists we submitted 25 women with genital prolapse to dynamic pelvigraphy; the prolapse was between 2 and 4° according to the HWS Baden–Walker classification, and the women did not show symptoms of obstructed defecation or active FI. In all 25 women (100%) we found an internal rectal prolapse associated with rectocele. In these patients, dynamic pelvigraphy showed that the rectum was emptied by the extrinsic compression of the uterus and bladder. We have used this observation to provide an explanation for evacuation in some of these patients, although they had a major internal rectal prolapse or rectocele. From 2000 to 2001, gynecologists submitted the aforementioned group of 25 women, plus a further 23 women with sim
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