Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Center of reconstructive urogenital surgery, Urologische Klinik, Planegg, Germany.
Int Urogynecol J. 2022 Nov;33(11):3261-3273. doi: 10.1007/s00192-022-05151-3. Epub 2022 Mar 28.
The objective was to investigate the symptom prevalence of anorectal dysfunction (AD) in women with pelvic organ prolapse (POP) and whether symptom improvement can be achieved by pelvic floor surgery.
Secondary analysis of the Propel Study data from 277 women with POP stage II-IV regarding bothersome AD symptoms, which were assessed using the Pelvic Floor Distress Inventory (PFDI) questionnaire preoperatively, and 6, 12, and 24 months after transvaginal prolapse repair with Elevate anterior and posterior.
Prevalence of AD was high in the study cohort (14.4-56.3%) and could be reduced significantly throughout a 2-year follow-up (cure rates 44.3-83.1%). AD symptoms decreased in a similar manner after posterior/apical fixation to the way they did after anterior/apical fixation (e.g., feeling of incomplete bowel emptying 66.7% to 25.5% vs 46.5% to 10.7% respectively). Hemorrhoids and loss of loose stool decreased even more after anterior/apical fixation than after posterior/apical fixation. Even though AD symptoms decreased significantly more in patients with POP stage III-IV, there was still a considerable improvement in patients with POP stage II (e.g., pain when passing stool 31.1 to 7.7% vs 21.4 to 0% respectively). Notably, even symptoms of hemorrhoids and rectal prolapse improved substantially (cure rates 44.2% and 70.1% respectively).
Symptoms of AD were frequent in our study cohort, and they significantly improved after vaginal mesh-augmented sacrospinous prolapse repair with Elevate anterior and posterior throughout the follow-up period. Anterior/apical fixation showed results that were almost as good as those after posterior/apical fixation. Patients with POP stage II experienced considerable symptom improvement, but cure rates were significantly higher in patients with POP stage III-IV. Vaginal mesh-augmented prolapse repair with good apical fixation is efficacious in resolving AD symptoms with low de novo rates in women suffering of POP.
目的是调查女性盆腔器官脱垂（POP）患者肛肠功能障碍（AD）的症状发生率，以及经阴道盆底修补术（Elevate 前、后修补术）能否改善这些症状。
对 277 例 II-IV 期 POP 患者的 Propel 研究数据进行二次分析，使用盆腔器官脱垂/尿失禁性功能问卷（Pelvic Floor Distress Inventory，PFDI）评估患者术前、术后 6、12 和 24 个月时的肛肠功能障碍症状。
研究队列中 AD 的发生率较高（14.4%-56.3%），且在 2 年随访期间显著降低（治愈率 44.3%-83.1%）。AP 固定和 PP 固定后 AD 症状均呈相似的下降趋势（如排便不尽感从 66.7%降至 25.5%和从 46.5%降至 10.7%）。痔和稀便失禁的改善程度在前 AP 固定后比在后 AP 固定后更明显。尽管 III-IV 期 POP 患者的 AD 症状显著改善，但 II 期 POP 患者的症状仍有明显改善（如排便疼痛从 31.1%降至 7.7%和从 21.4%降至 0%）。值得注意的是，即使是痔和直肠脱垂的症状也有了显著改善（治愈率分别为 44.2%和 70.1%）。
在我们的研究队列中，AD 症状较为常见，且经阴道网片增强骶棘韧带固定术（Elevate 前、后修补术）治疗后，在整个随访期间，AD 症状均显著改善。AP 固定的效果几乎与 PP 固定一样好。II 期 POP 患者的症状有明显改善，但 III-IV 期 POP 患者的治愈率明显更高。阴道网片增强修补术结合良好的顶极固定治疗女性 POP 患者的 AD 症状有效，且新发 AD 症状的发生率较低。
