The Effect of Transvaginal Prolapse Surgery on Anorectal Function

Abstract

Objective Pelvic floor dysfunction can manifest as a spectrum including anorectal dysfunction, vaginal prolapse, and urinary incontinence. Sacrospinous fixation is a procedure performed by gynecologists to treat vaginal prolapse. The present study aims to evaluate the impact of transvaginal prolapse surgery on anorectal function.

Materials and Methods We conducted a retrospective review of patients undergoing sacrospinous fixation surgery for vaginal prolapse between 2014 to 2020. Those with anorectal dysfunction who had also been evaluated by the colorectal service preoperatively and postoperatively were included for analysis. These patients were assessed with symptom-specific validated questionnaires. The effect of surgery on constipation and fecal incontinence symptoms was analyzed.

Results A total of 22 patients were included for analysis. All patients underwent transvaginal sacrospinous fixation, and 95.4% also had posterior colporrhaphy for vaginal prolapse. There were a statistically significant improvements in the Fecal Incontinence Severity Index (FISI), the St. Mark's Incontinence Score (Vaizey), the embarrassment and lifestyle components of the Fecal Incontinence Quality of Life Score, the Constipation Scoring System, the Obstructed Defecation Score, and components of the Patient Assessment of Constipation Quality of Life score.

Conclusion Transvaginal prolapse surgery leads to a favorable effect on anorectal function, with improvements in both obstructed defecation and fecal incontinence scores in this small series.

Keywords

obstructed defecation - fecal incontinence - transvaginal prolapse surgery - pelvic floor - sacrospinous fixation

Synopsis

Transvaginal prolapse surgery leads to a favorable effect on anorectal function with improvements in both obstructed defecation and fecal incontinence scores.

Author Contributions

AW and CG were involved in study conceptualization, design, and methodology. RC performed data collection and analysis, and wrote the original draft. All authors were involved in reviewing and editing the final manuscript.

Publikationsverlauf

Eingereicht: 08. Januar 2023

Angenommen: 23. Januar 2023

Artikel online veröffentlicht:
22. März 2023

• References

• 1 Jelovsek JE, Chagin K, Gyhagen M. et al. Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol 2018; 218 (02) 222.e1-222.e19
• 2 Rodríguez-Mias NL, Martínez-Franco E, Aguado J, Sánchez E, Amat-Tardiu L. Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors?. Eur J Obstet Gynecol Reprod Biol 2015; 190: 52-57
• 3 Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014; 123 (06) 1201-1206
• 4 Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 2011; 205 (03) 230.e1-230.e5
• 5 Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 2001; 185 (06) 1332-1337 , discussion 1337–1338
• 6 Cauley CE, Savitt LR, Weinstein M. et al. A Quality-of-Life Comparison of Two Fecal Incontinence Phenotypes: Isolated Fecal Incontinence Versus Concurrent Fecal Incontinence With Constipation. Dis Colon Rectum 2019; 62 (01) 63-70
• 7 Siproudhis L, Pigot F, Godeberge P, Damon H, Soudan D, Bigard MA. Defecation disorders: a French population survey. Dis Colon Rectum 2006; 49 (02) 219-227
• 8 Brown H, Grimes C. Current trends in management of defecatory dysfunction, posterior compartment prolapse, and fecal incontinence. Curr Obstet Gynecol Rep 2016; 5 (02) 165-171
• 9 Brown SR, Wadhawan H, Nelson RL. Surgery for faecal incontinence in adults. Cochrane Database Syst Rev 2013; 2013 (07) CD001757
• 10 Vitale SG, Laganà AS, Noventa M. et al. Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality. BioMed Res Int 2018; 2018: 5727165
• 11 Miller BJ, Seman EI, O'Shea RT, Hakendorf PH, Nguyen TTT. Recent trends in the management of pelvic organ prolapse in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2019; 59 (01) 117-122
• 12 Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 2005; 40 (05) 540-551
• 13 Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V. Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 2008; 10 (01) 84-88
• 14 Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996; 39 (06) 681-685
• 15 Rockwood TH, Church JM, Fleshman JW. et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 1999; 42 (12) 1525-1532
• 16 Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
• 17 Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut 1999; 44 (01) 77-80
• 18 Rockwood TH, Church JM, Fleshman JW. et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43 (01) 9-16 , discussion 16–17
• 19 Lamblin G, Delorme E, Cosson M, Rubod C. Cystocele and functional anatomy of the pelvic floor: review and update of the various theories. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27 (09) 1297-1305
• 20 Ahmad NZ, Stefan S, Adukia V, Naqvi SAH, Khan J. Laparoscopic ventral mesh rectopexy: functional outcomes after surgery. Surg J (NY) 2018; 4 (04) e205-e211
• 21 Liedl B, Inoue H, Sekiguchi Y. et al. Is overactive bladder in the female surgically curable by ligament repair?. Cent European J Urol 2017; 70 (01) 53-59
• 22 Hefni M, El-Toukhy T, Bhaumik J. Vaginal sacrospinous colpopexy and perineorrhaphy for faecal incontinence: preliminary report. Eur J Obstet Gynecol Reprod Biol 2003; 110 (02) 211-214
• 23 Dietz V, Huisman M, de Jong JM, Heintz PM, van der Vaart CH. Functional outcome after sacrospinous hysteropexy for uterine descensus. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (06) 747-752
• 24 Rostaminia G, Abramowitch S, Chang C, Goldberg RP. The role of conventional pelvic floor reconstructive surgeries in obstructed defecation symptoms change: CARE and OPTIMAL trials sub-analysis of 2-year follow-up data. Int Urogynecol J Pelvic Floor Dysfunct 2020; 31 (07) 1325-1334
• 25 Rostaminia G, Abramowitch S, Chang C, Goldberg RP. Transvaginal sacrospinous ligament suture rectopexy for obstructed defecation symptoms: 1-year outcomes. Int Urogynecol J Pelvic Floor Dysfunct 2021; 32 (11) 3045-3052
• 26 Jelovsek JE, Barber MD, Brubaker L. et al; NICHD Pelvic Floor Disorders Network. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA 2018; 319 (15) 1554-1565
• 27 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 (05) 423.e1-423.e5
• 28 Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 1997; 104 (01) 82-86
• 29 Grimes CL, Schimpf MO, Wieslander CK. et al; Society of Gynecologic Surgeons (SGS) Systematic Review Group (SRG). Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations. Int Urogynecol J Pelvic Floor Dysfunct 2019; 30 (09) 1433-1454