Injection sclerotherapy using aluminum potassium sulfate and tannic acid in the treatment of symptomatic rectocele: A prospective case series.

INTRODUCTION: Although various surgical techniques have been described for the treatment of rectocele, there is currently no method exhibiting overall superiority because of the different types of complications and varying rate of recurrence. The aim of this study was to evaluate the outcomes of injection sclerotherapy using aluminum potassium sulfate and tannic acid in the management of symptomatic rectocele. METHODS: Twelve patients were recruited and treated using injection sclerotherapy. Efficacy measures included changes in the Constipation Scoring System value and rectocele size. RESULTS: The median operative duration was 7.5 min (range, 3-16 min). Three months after treatment, the mean Constipation Scoring System value decreased significantly in comparison with the baseline value (8.9 ± 4.1 vs. 4.9 ± 2.8, P = 0.0014) and the mean rectocele size reduced significantly in comparison with the baseline size (3.8 ± 0.5 vs. 1.7 ± 0.9, P < 0.001). Regarding complications, a patient showed temporary fecal impaction after treatment. The recurrence rate at 4 years was 29% (95% confidence interval, 10%-66%). CONCLUSIONS: Injection sclerotherapy is quick, easy to perform, and offers reasonable mid-term outcomes; furthermore, it is associated with a low rate of complications. Therefore, it appears to be a reasonable alternative for patients with symptomatic rectocele.

Anterior rectocele due to obstructed defecation relieved by botulinum toxin.

Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P =.0003). At the same time, rectocele depth (mean +/- SD) was reduced from 4.3 +/- 0.6 cm to 1.8 +/- 0.5 cm (P =.0000001) and rectocele area from 9.2 +/- 1.3 cm(2) to 2.8 +/- 1.6 cm(2) (P =.0000001). Anorectal manometry demonstrated decreased tone during straining from 70 +/- 28 mm Hg at baseline to 41 +/- 19 mm Hg at 1 month (P =.003) and to 41 +/- 22 mm Hg at 2 months (P =.005). No permanent complications were observed in any patient for a mean follow-up period of 18 +/- 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement.