TY - JOUR
T1 - Prospective clinical and functional results of combined rectal and urogynecologic surgery in complex pelvic floor disorders
AU - Boccasanta, Paolo
AU - Venturi, Marco
AU - Spennacchio, Maurizio
AU - Buonaguidi, Arturo
AU - Airoldi, Angelo
AU - Roviaro, Giancarlo
PY - 2010/2
Y1 - 2010/2
N2 - 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.
AB - 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.
KW - Enterocele
KW - Obstructed defecation
KW - Pelvic floor disorders
KW - Stapled transanal rectal resection
KW - Stress urinary incontinence
KW - Vaginal hysterectomy
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U2 - 10.1016/j.amjsurg.2008.11.040
DO - 10.1016/j.amjsurg.2008.11.040
M3 - Article
C2 - 19362286
AN - SCOPUS:75049083502
VL - 199
SP - 144
EP - 153
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 2
ER -