ABSTRACT
BACKGROUND: The aim of this prospective study was to evaluate the results of combined rectal and urogynecologic surgery in women with associated obstructed defecation, urinary incontinence, or genital prolapse. METHODS: One hundred forty-two selected patients with obstructed defecation in isolation or associated with urinary incontinence, enterocele, or genital prolapse were consecutively operated on by stapled transanal rectal resection alone or associated with transobturator tape, vaginal repair of the enterocele, or vaginal hysterectomy, respectively, and followed up by clinical controls and defecography. RESULTS: At 2 years, all symptom, quality-of-life, and defecographic parameters had significantly improved in all groups (P < .001). The association with hysterectomy showed higher risk for severe complications, longer operative time, hospital stay, and time of inability (P < .001). Recurrence of urinary incontinence was observed in 3 of 24 patients, while 2 of 21 showed residual vaginal prolapse. CONCLUSION: The combination of rectal and urogynecologic surgery is effective, with higher morbidity in the association with vaginal hysterectomy. Randomized trials comparing surgery in 1 and more stages and longer follow-up are necessary for a definitive conclusion.
Subject(s)
Gynecologic Surgical Procedures/methods , Intestinal Obstruction/surgery , Pelvic Floor , Rectum/surgery , Surgical Stapling , Aged , Defecography , Digestive System Surgical Procedures/methods , Female , Herniorrhaphy , Humans , Hysterectomy, Vaginal/methods , Pelvic Organ Prolapse/surgery , Prospective Studies , Quality of Life , Surgical Tape , Urinary Incontinence, Stress/surgeryABSTRACT
OBJECTIVE: To assess the results of TVT in patients with urinary stress incontinence, urethral hypermobility, and low-pressure urethra. STUDY DESIGN: We retrospectively analysed 265 consecutive women who underwent a TVT procedure for urodynamic stress urinary incontinence over a 31-month period. Women were divided into two groups depending on their preoperative maximum urethral closure pressure (MUCP). Group 1 (61 women with MUCP
Subject(s)
Surgical Mesh , Urethra/physiopathology , Urinary Incontinence, Stress/surgery , Vagina/surgery , Female , Follow-Up Studies , Humans , Middle Aged , Retrospective Studies , Treatment Outcome , Urinary Incontinence, Stress/physiopathology , Urodynamics , Urologic Surgical ProceduresABSTRACT
OBJECTIVE: The purpose of this study was to compare 2 anti-incontinence procedures in women who had severe genital prolapse and potential stress incontinence. STUDY DESIGN: In addition to vaginal reconstructive surgery, 50 patients with stage II or higher anterior defect and a positive stress test result with prolapse reduction received either tension-free vaginal tape or plication of the endopelvic fascia. Preoperative evaluation included history, physical examination, stress test, and urodynamic assessment. Data were analyzed with the Student t test, the Fisher's exact test, and the Wilcoxon signed-rank test. RESULTS: The median follow-up time was similar for both groups, 26 and 24 months. Subjective (96% vs 64%; P=.01) and objective (92% vs 56%; P<.01) continence rates were higher after the tension-free vaginal tape procedure. Time for the resumption of spontaneous voiding, rates of urinary retention, or de novo urge incontinence were similar in the 2 groups. CONCLUSION: Tension-free vaginal tape can be recommended for patients with prolapse and occult stress incontinence.
Subject(s)
Fasciotomy , Pelvis , Surgical Mesh , Tissue Adhesives , Urinary Incontinence, Stress/surgery , Uterine Prolapse/surgery , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Treatment Outcome , Urinary Incontinence, Stress/complications , Urodynamics , Uterine Prolapse/complicationsABSTRACT
OBJECTIVE: To investigate risk factors and prevalence of anal incontinence among women with pelvic floor dysfunctions. METHODS: We evaluated 881 women with symptoms of urinary incontinence and/or genital prolapse. Each completed a bowel questionnaire and underwent a detailed medical, surgical, obstetric, and gynecologic history, and a pelvic examination. Additional testing, when indicated, included office cystometry or multichannel urodynamic evaluation. Multivariable analysis using logistic regression was used to test the overall significance of all variables significantly associated with anal incontinence, using univariate analysis. RESULTS: A total of 178 women had anal incontinence (20%). These patients were on average older, had a greater body mass index, and had larger birth weight infants than their anal-continent counterparts; 511 were diagnosed with urinary incontinence, and 122 (24%) also had anal incontinence. Women with urinary incontinence were more likely to report anal incontinence events than women continent of urine (24% versus 15%, P =.002). The following associations were found with anal incontinence: infant with birth weight 3800 g or greater (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1, 2.2), rectocele greater than grade 2 (OR 1.9, 95% CI 1.1, 3.3), urinary incontinence (OR 1.9, 95% CI 1.3, 2.8), hemorrhoidectomy (OR 2.7, 95% CI 1.1, 7.0), irritable bowel syndrome (OR 6.3, 95% CI 3.5, 11.5). CONCLUSION: Among women with symptoms of urinary incontinence and pelvic organ prolapse, the prevalence of anal incontinence was 20%. Urinary incontinence and severe rectocele were found to be associated with anal incontinence.