SGS meeting paper
Bowel symptoms in women 1 year after sacrocolpopexy

Presented at the 33rd Annual Scientific Meeting of the Society of Gynecologic Surgeons, Orlando, FL, April 12-14, 2007.
https://doi.org/10.1016/j.ajog.2007.08.023Get rights and content

Objective

The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy.

Study Design

This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II–IV prolapse. In addition to sacrocolpopexy (± Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon’s discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively.

Results

The sacrocolpopexy + PR group (n = 87) had more baseline obstructive colorectal symptoms (higher CRADI and CRADI-obstructive scores: P = .04 and < .01, respectively) than the sacrocolpopexy alone group (n = 211). CRADI total, obstructive, and pain/irritation scores significantly improved in both groups (all P < .01). Most bothersome symptoms resolved after surgery in both groups.

Conclusion

Most bowel symptoms improve in women with moderate to severe pelvic organ prolapse after sacrocolpopexy.

Section snippets

Materials and Methods

This study was a prospectively planned analysis of bowel symptoms in women enrolled in CARE,6, 7 a randomized trial of 322 women without stress incontinence symptoms who were planning sacrocolpopexy for stage II-IV prolapse. The CARE trial was performed through the Pelvic Floor Disorders Network (PFDN), a cooperative agreement network sponsored by the National Institute of Child Health and Human Development. Each PFDN site received institutional review board approval, and all women provided

Results

Of 305 CARE subjects who completed interviews 1 year after index surgery, 7 were excluded because of concurrent procedures for rectal prolapse (rectopexy and/or bowel resection) or fecal incontinence (anal sphincteroplasty), leaving 298 women in this study group. Eighty-seven women underwent sacrocolpopexy with concurrent posterior procedure(s), including posterior colporrhaphy (65), perineorrhaphy (64), and sacrocolpoperineopexy (19); many had more than 1 posterior procedure. Two hundred

Comment

This analysis shows that surgical correction of prolapse by abdominal sacrocolpopexy, performed with or without posterior procedure(s), is associated with statistically and clinically significant reductions in obstructive defecatory and other bowel symptoms, which persist for at least 1 year. Specifically, sacrocolpopexy resulted in a 71-88% reduction of bothersome symptoms of digital assistance to defecate, excessive straining, and a feeling of incomplete evacuation. These findings suggest

Acknowledgment

The authors thank Dr Robert Park, the Chair of the Pelvic Floor Disorders Network Steering Committee, for his contributions to the network.

References (23)

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    Bowel function in POP is complex and multifactorial [19,20]. Evidence from non-randomized control trials involving the repair of the prolapse of the posterior vaginal compartment suggests that the procedure improves the structural problem but that outcome on bowel symptoms is unpredictable [21]. In the current study, there was no significant deterioration in the reported impact of symptoms, but 40.7% of the women had de novo bowel symptoms.

  • Robotic-assisted sacrocolpopexy: early postoperative outcomes after surgical reduction of enlarged genital hiatus

    2018, American Journal of Obstetrics and Gynecology
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    In general, the anterior compartment is most commonly implicated after native tissue repair failures,4 whereas the posterior compartment has the highest propensity for failure after RSC.5 Studies have found that effective apical surgery, with or without concomitant posterior procedure(s), reduce symptoms of obstructed defecation,6 and that women with baseline posterior prolapse maintained good anatomic support up to 5 years after ASC despite the lack of a concomitant posterior repair.7 However, the aforementioned studies did not assess the impact of either preoperative or postoperative genital hiatus (GH) in their analyses.

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Cite this article as: Bradley CS, Nygaard IE, Brown MB, et al. Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol 2007;197:642.e1-642.e8.

This work was supported in part by Grants U01 HD41249, U10 HD41268, U10 HD41248, U10 HD41250, U10 HD41261, U10 HD41263, U10 HD41269, and U10 HD41267 from the National Institute of Child Health and Human Development.

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