Department of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK.
Department of Urogynaecology, Epsom and St Helier Hospitals NHS Trust, Surrey, Carshalton, UK.
J Obstet Gynaecol. 2021 May;41(4):594-600. doi: 10.1080/01443615.2020.1786805. Epub 2020 Aug 27.
The most appropriate method for repairing posterior vaginal wall prolapse is still debatable. Women with symptomatic prolapse scheduled to undergo surgical repair in the posterior compartment were randomised to standard posterior colporrhaphy (SPC) or fascial and vaginal epithelial plication (FEP). Participants were assessed with the Prolapse Quality of Life (P-QOL) questionnaire, pelvic organ prolapse quantification (POP-Q) examination and three-dimensional ultrasound (3D US) prior to surgery and 6 months postoperatively. The research hypothesis is that 3D US of the pelvic floor is a reliable tool in comparing the anatomical outcomes of the two different surgical techniques. Differences in anatomical outcomes, assessed clinically and by ultrasonographic evaluation, were compared between the two groups using the Independent Mann-Whitney -test and the Wilcoxon signed-rank sum test. Twenty-two women were included in the analysis. Six months postoperatively, women in the FEP arm had better anatomical outcomes compared to those who had undergone SPC ( = .02). Repeatability of the ultrasound technique was confirmed, showing moderate to very good agreement in all parameters and the 3D US evaluation was corroborated with the clinical examination, showing a greater reduction in the urogenital size in the FEP group.Impact statement The low cost and universal availability of the ultrasound (US) makes it the most commonly used diagnostic modality. The ability to see beyond surface anatomy is important and useful in the assessment of the posterior vaginal wall prolapse and the obstructed defaecation, where this method may replace the defaecation proctography (Dietz 2019). Recent advances in pelvic floor ultrasonography (3D US) have achieved repeatability in the measurement of the levator hiatal (LH) dimensions, introducing a valid and readily available tool for researchers and clinicians (Dietz et al. 2005). Ultrasound may distinguish a true rectocele due to the weakening of the rectovaginal fascia from an enterocele, a rectal intussusception, or just a deficient perineum (Guzman Rojas et al. 2016). Our study demonstrates that 3D translabial pelvic floor ultrasound is a useful and reliable tool in assessing the anatomical outcome of prolapse surgery. Our study demonstrates that 3D translabial ultrasound of the pelvic floor is a useful and reproducible method in evaluating the anatomical outcomes of surgical repair for posterior wall prolapse. Genital hiatus (GH) and levator hiatus (LH) dimensions measured by ultrasound can be used as surrogate anatomical markers in comparing the efficacy of different surgical techniques.
修复阴道后壁脱垂的最合适方法仍存在争议。计划在后部进行手术修复的有症状脱垂的女性被随机分为标准后阴道修补术（SPC）或筋膜和阴道上皮折叠术（FEP）。在术前和术后 6 个月，参与者使用脱垂生活质量（P-QOL）问卷、盆腔器官脱垂量化（POP-Q）检查和三维超声（3D-US）进行评估。研究假设是，盆底的 3D-US 是比较两种不同手术技术解剖结果的可靠工具。通过独立的曼惠特尼 -U 检验和 Wilcoxon 符号秩和检验，比较两组之间临床和超声评估的解剖学结果差异。22 名女性被纳入分析。术后 6 个月，FEP 组的女性在解剖学结果方面优于 SPC 组（=0.02）。超声技术的可重复性得到确认，所有参数均显示出中度至非常好的一致性，3D-US 评估与临床检查结果相符，FEP 组的尿生殖大小减少更为明显。
影响声明
超声（US）的低成本和普遍可用性使其成为最常用的诊断方式。能够看到表面解剖结构之外的情况对于评估阴道后壁脱垂和阻塞性排便非常重要和有用，在这种情况下，这种方法可能会取代排便直肠造影（Dietz 2019）。最近，盆底超声（3D-US）的进展在测量提肛裂孔（LH）的尺寸方面取得了可重复性，为研究人员和临床医生引入了一种有效且易于获得的工具（Dietz 等人，2005）。超声可以区分由于直肠阴道筋膜薄弱引起的真性直肠前突与肠疝、直肠内陷或仅仅是会阴不足（Guzman Rojas 等人，2016）。我们的研究表明，3D 经会阴盆底超声是评估脱垂手术解剖学结果的有用且可靠的工具。我们的研究表明，3D 经会阴盆底超声是评估阴道后壁脱垂手术修复后解剖学结果的有用且可重复的方法。超声测量的生殖器裂孔（GH）和提肛裂孔（LH）尺寸可用作比较不同手术技术疗效的替代解剖学标志物。
