Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, 2650, Edegem, Belgium.
Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
Int Urogynecol J. 2023 Nov;34(11):2629-2645. doi: 10.1007/s00192-023-05508-2. Epub 2023 Apr 19.
The aim of our study is to systematically review the literature about available devices facilitating perineal support during defecation in patients with obstructive defecation syndrome (ODS) and posterior pelvic organ prolapse (POP).
We searched for the terms "defecat/ion or ODS" and" pessar/ies or device/aid/tool/perineal/perianal/prolapse and support" in MEDLINE, PubMed and Web of Science. Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines. A two-stage inclusion was performed, selecting first on title and abstract and secondly the full text. For variables with sufficient data, a meta-analysis was performed using a random-effects model. Other variables were descriptively reported.
Ten studies out of 1332 were included for systematic review. The devices could be categorized into three groups: pessaries (n = 8), vaginal stent (n = 1) and external support device (n = 1). Methodology and data reporting is heterogeneous. Meta-analysis could be performed for the Colorectal-Anal Distress Inventory (CRADI-8) and Impact Questionnaire (CRAI-Q-7) in three pessary studies which showed a significant mean change. Significant improvement of stool evacuation was seen in two other pessary studies. The vaginal stent significantly decreases ODS. Subjective perception of constipation improved significantly using the posterior perineal support device.
All reviewed devices seem to improve ODS in patients with POP. There are no data on their efficacy with regard to perineal descent-associated ODS. There is a lack of comparative studies between devices. Studies are difficult to compare due to different inclusion criteria and evaluation tools.
本研究旨在系统回顾关于有助于排便时会阴支持的可用装置的文献，这些装置用于患有阻塞性排便综合征（ODS）和后盆腔器官脱垂（POP）的患者。
我们在 MEDLINE、PubMed 和 Web of Science 中搜索了“defecat/ion 或 ODS”和“pessar/ies 或 device/aid/tool/perineal/perianal/prolapse 和 support”的术语。根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行数据提取。采用两阶段纳入法，首先根据标题和摘要进行选择，然后选择全文。对于具有足够数据的变量，使用随机效应模型进行荟萃分析。其他变量则进行描述性报告。
在 1332 篇文章中，有 10 篇被纳入系统评价。这些装置可分为三组：子宫托（n=8）、阴道支架（n=1）和外部支撑装置（n=1）。方法学和数据报告具有异质性。在 3 项子宫托研究中，可对肛肠窘迫量表（CRADI-8）和影响问卷（CRAI-Q-7）进行荟萃分析，显示出显著的平均变化。另外 2 项子宫托研究显示粪便排空显著改善。阴道支架显著改善 ODS。使用后会阴支撑装置，主观便秘感觉显著改善。
所有回顾的装置似乎都能改善 POP 患者的 ODS。关于它们在与会阴下降相关的 ODS 方面的疗效，尚无数据。缺乏装置之间的比较研究。由于不同的纳入标准和评估工具，研究难以比较。
