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Hans Peter Dietz - One of the best experts on this subject based on the ideXlab platform.
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association between vaginal parity and Rectocele
International Urogynecology Journal, 2018Co-Authors: Hans Peter Dietz, Mariangeles Gomez, Ixora Kamisan Atan, Caroline Wanderley FerreiraAbstract:INTRODUCTION AND HYPOTHESIS: Rectocele is common in parous women but also seen in nulliparae. This study was designed to investigate the association between vaginal parity and descent of the rectal ampulla/Rectocele depth as determined by translabial ultrasound (TLUS). METHODS: This retrospective observational study involved 1296 women seen in a urogynaecological centre. All had undergone an interview, clinical examination and 4D ultrasound (US) imaging supine and after voiding. Offline analysis of volume data was undertaken blinded against other data. Rectal ampulla position and Rectocele depth were measured on Valsalva. A pocket depth of 10 mm was used as a cutoff to define Rectocele on imaging. RESULTS: Most women presented with prolapse (53%, n = 686); 810 (63%) complained of obstructed defecation (OD). Clinically, 53% (n = 690) had posterior-compartment prolapse with a mean Bp of -1 [standard deviation (SD)1.5; -3 to 9 cm]. Mean descent of the rectal ampulla was 10 mm below the symphysis (SD 15.8; -50 to 41). A Rectocele on imaging was found in 48% (n = 618). On univariate analysis, OD symptoms were strongly associated with rectal descent, Rectocele depth and Rectocele on imaging (all P < 0.001). The prevalence of a Rectocele seen on imaging increased with vaginal parity (P < 0.001). One-way analysis of variance (ANOVA) of vaginal parity against rectal descent and Rectocele depth showed a dose-response relationship (both P < 0.001). CONCLUSIONS: Vaginal parity was strongly associated with descent of the rectal ampulla and Rectocele depth. This relationship approximated dose-response characteristics, with the greatest effect due to the first vaginal delivery.
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Association between vaginal parity and Rectocele.
International Urogynecology Journal, 2018Co-Authors: Hans Peter Dietz, Mariangeles Gomez, Ixora Kamisan Atan, Caroline S. Wanderley FerreiraAbstract:INTRODUCTION AND HYPOTHESIS: Rectocele is common in parous women but also seen in nulliparae. This study was designed to investigate the association between vaginal parity and descent of the rectal ampulla/Rectocele depth as determined by translabial ultrasound (TLUS). METHODS: This retrospective observational study involved 1296 women seen in a urogynaecological centre. All had undergone an interview, clinical examination and 4D ultrasound (US) imaging supine and after voiding. Offline analysis of volume data was undertaken blinded against other data. Rectal ampulla position and Rectocele depth were measured on Valsalva. A pocket depth of 10 mm was used as a cutoff to define Rectocele on imaging. RESULTS: Most women presented with prolapse (53%, n = 686); 810 (63%) complained of obstructed defecation (OD). Clinically, 53% (n = 690) had posterior-compartment prolapse with a mean Bp of -1 [standard deviation (SD)1.5; -3 to 9 cm]. Mean descent of the rectal ampulla was 10 mm below the symphysis (SD 15.8; -50 to 41). A Rectocele on imaging was found in 48% (n = 618). On univariate analysis, OD symptoms were strongly associated with rectal descent, Rectocele depth and Rectocele on imaging (all P
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how large does a Rectocele have to be to cause symptoms a 3d 4d ultrasound study
International Urogynecology Journal, 2015Co-Authors: Hans Peter Dietz, Ka Lai Shek, X Zhang, Rojas R GuzmanAbstract:Introduction Rectocele is a common condition, which on imaging is defined by a pocket identified on Valsalva or defecation. Cut-offs of 10 and 20 mm for pocket depth have been described. This study analyses the correlation between Rectocele depth and symptoms of bowel dysfunction to define a cut-off for the diagnosis of “significant Rectocele” on ultrasound.
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does childbirth play a role in the etiology of Rectocele
International Urogynecology Journal, 2015Co-Authors: Rodrigo Guzman Rojas, Christian Quintero, Ka Lai Shek, Hans Peter DietzAbstract:Introduction and hypothesis Rectoceles are common among parous women and they are believed to be due to disruption or distension of the rectovaginal septum as a result of childbirth. However, the etiology of Rectocele is likely to be more complex since posterior compartment prolapse does occur in nulliparous women. This study was designed to determine the role of childbearing as an etiological factor in true radiological Rectocele.
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Rectocele or stool quality what matters more for symptoms of obstructed defecation
Techniques in Coloproctology, 2009Co-Authors: Hans Peter DietzAbstract:Background Rectocele is a common condition seen in patients presenting with symptoms of obstructed defecation. We designed a prospective observational study to investigate the relative roles of Rectocele and stool quality for such symptoms.
R K S Phillips - One of the best experts on this subject based on the ideXlab platform.
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relationship between anatomic and symptomatic long term results after Rectocele repair for impaired defecation
Diseases of The Colon & Rectum, 1999Co-Authors: C J H M Van Laarhoven, Steve Halligan, C I Bartram, Michael A Kamm, P R Hawley, R K S PhillipsAbstract:PURPOSE: The aim of this study was to determine the long-term symptomatic and anatomic results of Rectocele repair for impaired defecation. METHODS: All 26 females operated on during a five-year period in one hospital were reviewed in clinic. Follow-up was available on 22 patients after a median of 27 (range, 5–54) months. Interview, anorectal physiological testing, and evacuation proctography were performed preoperatively and postoperatively. Fifteen patients had a transperineal repair and seven patients had a transanal repair. RESULTS: Sixteen (73 percent) patients felt improved. A feeling of incomplete emptying (19vs. 10, preoperativevs. postoperative;P=0.02) and the need to use digital assistance vaginally (13vs. 6;P=0.07) were both reduced by surgery, the former being improved significantly more often after transperineal repair. The Rectocele width and area were reduced by both types of surgery; however, the Rectocele diameter was greater than 2 cm in 16 patients preoperatively and 10 patients postoperatively. There was no significant difference between patients who did or did not feel improved by surgery in the percentage reduction in Rectocele width (22vs. 18 percent;P=0.95), the percentage reduction in Rectocele area (65vs. 62 percent;P=0.95), or a Rectocele width of more than 2 cm (44vs. 50 percent;P=0.80), didvs. did not feel improved, respectively. CONCLUSION: Operative repair symptomatically improves a majority of patients with impaired defecation associated with a large Rectocele, but the improvement probably relates at least in part to factors other than the dimensions of the Rectocele.
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transperineal repair of symptomatic Rectocele with marlex mesh a clinical physiological and radiologic assessment of treatment
Journal of The American College of Surgeons, 1996Co-Authors: S Watson, Steve Halligan, P B Loder, C I Bartram, Michael A Kamm, R K S PhillipsAbstract:BACKGROUND: The aim of this study was to evaluate the operative repair of Rectoceles in a defined group of women by a technique designed to deal with the cause (failure of the rectovaginal septum) rather than the effect (rectal and vaginal wall bulging). STUDY DESIGN: Only women whose defecation was aided by vaginal digitation and who had large Rectoceles on proctography were included. Any other clinical symptoms in the absence of vaginal digitation, even when proctography demonstrated a Rectocele, were not taken as indicators for surgery in this study. There were nine women, median age 50 years (range, 32 to 61). The rectovaginal septum was repaired with Marlex mesh through a perineal approach by one surgeon. The median follow-up period was 29 months. RESULTS: Eight of the nine women achieved successful evacuation after surgery without the need for vaginal digitation. Rectocele size, depth, and the percent of barium trapped in the Rectocele on proctography were all improved. Anorectal physiology measurements were unchanged by surgery. CONCLUSIONS: Operative repair of the rectovaginal septum removes the need for vaginal digitation in most women with large Rectoceles on proctography. Further studies in well-defined groups of women are needed to establish how well Rectocele repair aids women with a variety of other pelvic and perineal symtoms.
Anders F Mellgren - One of the best experts on this subject based on the ideXlab platform.
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Rectocele repair using biomaterial augmentation current documentation and clinical experience
Obstetrical & Gynecological Survey, 2005Co-Authors: Daniel Altman, Anders F Mellgren, Jan ZetterstromAbstract:UNLABELLED: Although the etiology of Rectocele remains debated, surgical innovations are currently promoted to improve anatomic outcome while avoiding dyspareunia and alleviating rectal emptying difficulties following Rectocele surgery. Use of biomaterials in Rectocele repair has become widespread in a short time, but the clinical documentation of their effectiveness and complications is limited. Medline and the Cochrane database were searched electronically from 1964 to May 2005 using the Pubmed and Ovid search engines. All English language publications including any of the search terms "Rectocele," "implant," "mesh," "biomaterial," "prolapse," "synthetical," "pelvic floor," "biological," and "compatibility" were reviewed. This review outlines the basic principles for use of biomaterials in pelvic reconstructive surgery and provides a condensation of peer-reviewed articles describing clinical use of biomaterials in Rectocele surgery. Historical and new concepts in Rectocele surgery are discussed. Factors of importance for human in vivo biomaterial compatibility are presented together with current knowledge from clinical studies. Potential risks and problems associated with the use of biomaterials in Rectocele and pelvic reconstructive surgery in general are described. Although use of biomaterials in Rectocele and other pelvic organ prolapse surgery offers exciting possibilities, it raises treatment costs and may be associated with unknown and potentially severe complications at short and long term. Clinical benefits are currently unknown and need to be proven in clinical studies. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians TARGET AUDIENCE: After completion of this article, the reader should be able to explain that the objective of surgical treatment is to improve anatomic outcome and alleviate rectal emptying difficulties, describe the efficacy of biomaterials in Rectocele repair, and summarize the potential risks and problems associated with use of biomaterials in Rectocele and pelvic reconstructive surgery.
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functional and anatomic outcome after transvaginal Rectocele repair using collagen mesh a prospective study
Diseases of The Colon & Rectum, 2005Co-Authors: Daniel Altman, Bo Anzen, Annika Lopez, Jan Zetterstrom, Christian Falconer, Fredrik Hjern, Anders F MellgrenAbstract:PURPOSE: This study was designed to evaluate Rectocele repair using collagen mesh. METHODS: 32 female patients underwent surgical repair using collagen mesh. Outcome was assessed in 29 patients and preoperative assessment included standardized questionnaire, clinical examination, and defecography. At the six-month follow-up, patients answered a standardized questionnaire and underwent clinical examination. At the 12-month follow-up, patients answered a standardized questionnaire, underwent clinical examination, and defecography. RESULTS: Preoperatively, 26 patients had a Stage II and 3 patients had a Stage III Rectocele. At the 6-month follow-up, five patients had Rectocele ≥ Stage II (P < 0.001) and at the 12-month follow-up, seven patients had Rectocele ≥ Stage II (P < 0.001) at clinical examination. At the preoperative defecography, all patients presented a Rectocele. At the 12-month defecography, 14 patients had no Rectocele (P < 0.001) and 15 had a Rectocele. At the six-month follow-up, there was a significant decrease in rectal emptying difficulties, need of digital support of the posterior vaginal wall at defecation, and defecation frequency. At the 12-month follow-up, symptom improvement remained, but was less pronounced. CONCLUSIONS: Rectocele repair using collagen mesh improved anatomic support, but there is a substantial risk for recurrence with unsatisfactory anatomic and functional outcome one year after surgery. Rectocele repair using mesh was not associated with an increased risk of dyspareunia. Rectocele repair using biomaterial mesh reinforcement needs further evaluation before adopted into clinical practice.
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Rectocele is associated with paradoxical anal sphincter reaction
International Journal of Colorectal Disease, 1998Co-Authors: Anders F Mellgren, Annika Lopez, Inkeri Schultz, Bo AnzenAbstract:Rectocele is a frequent finding in constipated patients. However, constipation is not always relieved by Rectocele repair, which may be due to other overlooked reasons for constipation. The study was designed to investigate patients with Rectocele, in order to elucidate concomitant colorectal disorders and their association with Rectocele. One hundred and twelve female patients suffering from severe constipation and rectal emptying difficulties were investigated using defecography, electrophysiology, anorectal manometry and colon transit time. Fifty-six patients with Rectocele demonstrated by defecography were compared with 56 patients without Rectocele, but with other abnormal findings at defecography. The frequency of paradoxical anal sphincter reaction (PSR) was higher in patients with Rectocele (60%) than in patients without Rectocele (24%). The present study supports an association between Rectocele and PSR. We suggest that constipated patients with a Rectocele should be investigated thoroughly before Rectocele repair is considered. Further studies on the effect of biofeedback training in patients with Rectocele and PSR are indicated.
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results of Rectocele repair a prospective study
Diseases of The Colon & Rectum, 1995Co-Authors: Anders F Mellgren, Bo Anzen, Bengt Y Nilsson, C Johansson, Anders Dolk, Peter Gillgren, Staffan Bremmer, Bo HolmstromAbstract:PURPOSE: This study was designed to evaluate the results of Rectocele repair and parameters that might be useful in selecting patients for this operation. METHODS: Twentyfive patients with symptom-giving Rectoceles were prospectively evaluated with a standardized questionnaire, physical examination, defecography, colon transit studies, anorectal manometry, and electrophysiology. Patients underwent posterior colporrhaphy and perineorrhaphy. They were followed postoperatively (mean, 1.0 year) with the same questionnaire, physical examination, defecography, anorectal manometry, and electrophysiology. RESULTS: Constipation had improved postoperatively in 21 of 24 constipated patients (88 percent). At postoperative follow-up 13 patients (52 percent) had no constipation symptoms, 8 (32 percent) had occasional symptoms, and 4 (16 percent) had symptoms more than once per week. Four patients with Rectocele at preoperative defecography, but not at physical examination, had favorable outcomes following surgery. The majority of patients not using vaginal digitalization preoperatively had improved with respect to constipation. All patients with pathologic transit studies had various degrees of constipation postoperatively. Constipation was not improved in two of five patients with preoperative paradoxic sphincter reaction. CONCLUSIONS: Rectocele is one cause of constipation that can be treated with good results. Preoperative use of vaginal digitalization is not mandatory for a good postoperative result. Defecography is an important complement to physical examination. Patients with pathologic transit study might have a less favorable outcome of Rectocele repair with respect to constipation. More studies about the significance of paradoxic sphincter reaction in these patients are indicated.
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association between Rectocele and paradoxical sphincter response
Diseases of The Colon & Rectum, 1992Co-Authors: C Johansson, Bengt Y Nilsson, Anders Dolk, Bo Holmstrom, Anders F MellgrenAbstract:Rectocele as well as paradoxical sphincter reaction may lead to rectal emptying difficulties and outlet obstruction. Forty-one patients with emptying disturbances and Rectocele were investigated with defecography, anorectal manometry, colon transit time, and electromyography. Twenty-nine patients (71 percent) had concomitant paradoxical sphincter reaction, and 13 of these also had increased colon transit time. The functional results after surgical treatment of Rectocele are not always satisfactory, probably because patients often have several causes for their emptying disturbances. It is emphasized that careful preoperative investigations are important before surgical treatment of Rectocele in patients with emptying difficulties.
Asad Kutup - One of the best experts on this subject based on the ideXlab platform.
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Quo Vadis STARR? A Prospective Long-Term Follow-Up of Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome
Journal of Gastrointestinal Surgery, 2010Co-Authors: Oliver Zehler, Yogesh K. Vashist, Dean Bogoevski, Maximillian Bockhorn, Emre F. Yekebas, Jakob R. Izbicki, Asad KutupAbstract:Introduction Functional and clinical long-term outcome after stapled transanal rectal resection (STARR) in patients with an isolated symptomatic Rectocele are investigated. Short-term results after 1 year are comparable with the functional outcome even after 5 years. Eighty per cent of the patients were still satisfied. STARR is an alternative procedure to the conventional surgical approaches for patients with an obstructed defecation syndrome and Rectocele. Several studies have reported short-term outcome after STARR, but long-term results are still missing. The objective of this study was to evaluate long-term clinical outcome after STARR with a follow-up of 5 years. Materials and Methods Twenty patients with only an isolated symptomatic Rectocele due to obstructed defecation syndrome were subjected to STARR. Functional and clinical outcome was assessed by Outlet Obstruction Syndrome score (OOS score), Wexner score (WS), and Symptome Severity score (SSS score). Data were prospectively collected over 7 years. Results The perioperative morbidity after STARR accounted for 20% ( n = 4). One patient was subjected to reoperation due to perforation, two postoperative bleedings occurred, and one patient developed an increasing local granulomatous reaction at the stapler line. The median follow-up accounted for 66 months (range 60–84). Sixteen patients (80%) were satisfied with the functional outcome. The median OOS, SSS and WS score improved significantly already after 1 year in these patients and remained stable at 5-year follow-up. In contrast, four patients were classified as treatment failures since the OOS score and the SSS score showed no improvement. At 5-year follow-up, these patients remained symptomatic without improvement in OOS and SSS scores. Conclusions The STARR procedure is an effective operation in isolated symptomatic Rectoceles with regard to relief of the obstructed defecation syndrome. The short-term improvement after STARR predicts long-term outcome in obstructed defecation syndrome caused by a Rectocele.
Steven D. Wexner - One of the best experts on this subject based on the ideXlab platform.
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Anal manometric predictors of significant Rectocele in constipated patients.
Techniques in Coloproctology, 2002Co-Authors: Nicolas A. Rotholtz, Jonathan Efron, Eric G. Weiss, Juan J. Nogueras, Steven D. WexnerAbstract:The diagnosis of significant Rectocele is currently made on the basis of cinedefecographic findings. Clinical examination alone will only allow assessment of the presence but not the significance of a Rectocele. Therefore, the aim of this study was to determine if anal manometric findings can predict the significance of a Rectocele. All patients with a diagnosis of constipation and Rectocele confirmed on cinedefecography between 1992 and 1998 were retrospectively reviewed. Significant Rectocele was defined as the presence of three of the following five parameters: Rectocele >4 cm in diameter as measured during the evacuatory phase of cinedefecography, rectal and/or vaginal symptoms present for longer than 12 months, persistence of rectal or vaginal symptoms for at least four weeks, despite increased dietary fiber (up to 35 g/day), need for rectal and/or vaginal digitation or perineal support maneuvers for rectal evacuation. Statistical analysis was performed using the Mann-Whitney test and Fisher's exact test. A logistic regression model with stepwise selection was used to determine significant prognostic factors. A total of 305 patients (31 men) with Rectocele, with a median age of 68 years (range, 12–89) were identified. Of these, 89 (29.2%) had significant Rectoceles. There was no difference in the frequency of significant and non-significant Rectoceles with respect to gender or age. However, patients with a significant Rectocele compared to those with a non-significant Rectocele had higher median first sensation volume (45 vs. 30 ml, p=0.0005), median capacity (160 vs. 120 ml, p
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anal manometric predictors of significant Rectocele in constipated patients
Techniques in Coloproctology, 2002Co-Authors: Nicolas A. Rotholtz, Jonathan Efron, Eric G. Weiss, Juan J. Nogueras, Steven D. WexnerAbstract:The diagnosis of significant Rectocele is currently made on the basis of cinedefecographic findings. Clinical examination alone will only allow assessment of the presence but not the significance of a Rectocele. Therefore, the aim of this study was to determine if anal manometric findings can predict the significance of a Rectocele. All patients with a diagnosis of constipation and Rectocele confirmed on cinedefecography between 1992 and 1998 were retrospectively reviewed. Significant Rectocele was defined as the presence of three of the following five parameters: Rectocele >4 cm in diameter as measured during the evacuatory phase of cinedefecography, rectal and/or vaginal symptoms present for longer than 12 months, persistence of rectal or vaginal symptoms for at least four weeks, despite increased dietary fiber (up to 35 g/day), need for rectal and/or vaginal digitation or perineal support maneuvers for rectal evacuation. Statistical analysis was performed using the Mann-Whitney test and Fisher's exact test. A logistic regression model with stepwise selection was used to determine significant prognostic factors. A total of 305 patients (31 men) with Rectocele, with a median age of 68 years (range, 12–89) were identified. Of these, 89 (29.2%) had significant Rectoceles. There was no difference in the frequency of significant and non-significant Rectoceles with respect to gender or age. However, patients with a significant Rectocele compared to those with a non-significant Rectocele had higher median first sensation volume (45 vs. 30 ml, p=0.0005), median capacity (160 vs. 120 ml, p<0.0001), and median compliance (10 vs. 8 ml H2O/mmHg, p=0.05). Calculations based on a logistic regression model determined that with a first sensation of 100 ml, a capacity of 400 ml, and a compliance of 50 ml/mmHg, the probability of a significant Rectocele would be 85%.In conclusion, anal manometric findings may be useful in predicting significant Rectocele in constipated patients.
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prognostic significance of Rectocele intussusception and abnormal perineal descent in biofeedback treatment for constipated patients with paradoxical puborectalis contraction
Diseases of The Colon & Rectum, 2000Co-Authors: Steve Heymen, Omer Alabaz, Augustine J N Iroatulam, Steven D. WexnerAbstract:PURPOSE: The findings of paradoxical puborectalis contraction, Rectocele, sigmoidocele, intussusception, and abnormal perineal descent often coexist in constipated patients, as noted by defecographic study. Moreover, some of these conditions are often found in asymptomatic patients. Biofeedback is the treatment of choice for constipated patients with paradoxical puborectalis contraction; the main determinant of successful biofeedback is patient compliance. The significance of coexistent and highly prevalent variants, such as Rectocele, intussusception, sigmoidocele, or abnormal perineal descent, on the success of biofeedback is unknown. This review was designed to assess whether these coexisting defecographic findings have any prognostic significance for the outcome of biofeedback. METHODS: From July 1988 to December 1996, 209 constipated patients with paradoxical puborectalis contraction underwent biofeedback treatment after defecography. A total of 173 patients (120 females) who had more than one biofeedback session after defecography formed the study group. Defecographic findings included concomitant Rectoceles, 40 (23 percent); evidence of circumferential intussusception, 17 (10 percent); sigmoidocele, 13 (8 percent); and abnormal perineal descent, 109 (63 percent). RESULTS: Whereas 65 patients failed to complete the course of biofeedback therapy, 108( 62.4 percent) patients completed the course of biofeedback and were discharged by the therapist. Within the completed group 59 (55 percent) improved, and 49 (45 percent) patients failed biofeedback therapy. In the improved group 14 (23.7 percent) had a Rectocele, 5 (8.5 percent) had intussusception, 5( 8.5 percent) had a sigmoidocele, and 37 (62.7 percent) had abnormal perineal descent. In the failure group 9 (18.4 percent) had a Rectocele, 5 (10.2 percent) had an intussusception, 2 (4.1 percent) had a sigmoidocele, and 31 (63.3 percent) had abnormal perineal descent (P=not significant). The success of biofeedback was then analyzed relative to the number of coexisting conditions. Specifically, the outcome in patients with paradoxical puborectalis contraction alone and with one, two, and three other defecographic findings were compared. No statistically significant difference was found among these four groups. CONCLUSION: Although other defecographic findings frequently coexist with paradoxical puborectalis contraction, none of the concomitant findings adversely affected the outcome of biofeedback treatment. Therefore, biofeedback can be recommended to patients with coexistent defecographic findings, with expectation of success in over 50 percent of individuals who complete the course of therapy.
