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Perineorrhaphy quantitative assessment (Pe-QA)

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Abstract

Introduction and hypothesis

Perineorrhaphy (Pe) has not been subject to a comprehensive perioperative quantitative assessment (QA). We wish to nominate such an assessment (Pe-QA) for any Pe, through testing the QA on the excision of the perineal gap (PG) at the time of posterior repair (PR).

Methods

At 50 consecutive PRs, the following measurements were taken pre- and postoperatively: (i) perineorrhaphy width (PW) equals PG [1]; (ii) perineorrhaphy depth (PD); (iii) perineal length (PL); (iv) midperineal thickness (MPT); (v) genital hiatus (GH) and (vi) total posterior vaginal length (TPVL). The total vaginal length was also measured. Surgical details deemed appropriate to each repair were recorded.

Results

The overall means and ranges (cm) were: (i) PW 2.9 (1.5–5.5); (ii) PD 1.6 (0.8–2.0); (iii) PL 2.9 (1.5–4.5); (iv) MPT 0.7 (0.4–1.1); (v) GH 3.9 (2.3–6.5); (vi) TPVL 9.2 (6.0–12.5). Excision of PG (100 % cases reducing PW and PD to zero) resulted in a mean 23.6 % increase in total vaginal length over that if the repair was commenced at the hymen, despite a 3.3 % decrease in the TPVL perioperatively. There was a mean 30.8 % reduction in the GH, a mean 27.6 % increase in the PL and a mean 57.1 % increase in the MPT.

Conclusions

Pe and the anatomical results of such surgery can be subject to quantitative assessment allowing comparison studies between different forms of Pe and possibly other types of perineal surgeries.

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References

  1. Haylen BT, Avery D, Chiu TL, Birrell W (2014) Posterior repair quantification (PR-Q) using key anatomical indicators (KAI) – Preliminary Report. International Urogynecological Journal. Published online May: DOI: 10.007/s00192-014-2433-7

  2. DeLancey JOL (1992) Anatomic aspects of vaginal eversion after hysterectomy. Amer J Obstet Gynecol 166:1717–1728

    Article  CAS  Google Scholar 

  3. Dua A, Whitworth M, Hill S (2008) Perineal length: Relationship between the length of the perineum and ethnic origin. Abstracts International Continence Society Cairo. October. www.ics.org/Abstracts/Publish/46/000161.pdf

  4. Bump RC, Mattiasson A, Bo K, Brubaker LP et al (1996) The standardization of female pelvic organ prolapse and pelvic floor dysfunction. Amer J Obstet Gynecol 175(1):10–11

    Article  CAS  Google Scholar 

  5. Yang A, Mostwin J, Genadry R, Sanders R (1993) Patterns of prolapse demonstrated with dynamic fastscan MRI; reassessment of conventional concepts of pelvic floor weaknesses. Neurourol Urodyn 12(4):310–311

    Google Scholar 

  6. Fowler GE, Richmond DH (2011) Operations for pelvic organ prolapse. In: Lopes T, Spirtos NM, Naik R, Monaghan JM Bonney’s Gynaecological Surgery. 11th Edition. Wiley-Blackwell London. Chapter 16. P154

  7. Nichols DH, Randall CL (1996) Posterior colporrhaphy and perineorrhaphy. In Nichols DH, Randall CL Vaginal Surgery 4th Edition. Williams & Wilkins. Baltimore. Chapter 11 p279

  8. Haylen BT, Freeman RM, de Ridder D, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk D, Sand P, Schaer G (2010) An International Urogynecological Association (IUGA) – International Continence Society (ICS) Joint Report into the Terminology for Female Pelvic Floor Dysfunction. Neurourology & Urodynamics, 29:4–20. International Urogynecology J 21:5–26

    Article  Google Scholar 

  9. Blomquist JL, Cundiff GW (2008) Posterior support defects. In Bent AE, Cundiff GW, Swift SE. Ostergard’s Urogynecology and Pelvic Floor Dysfunction. Lippincott, Williams & Wilkins. Philadelphia. Chapter 30. P500

  10. Pancholy AB, Silva WA, Karram MM (2010) Rectocele- Anatomic and Functional Repair. In: Cardozo L, Staskin D. Textbook of Female Urology and Urogynecology. Informa. London. Chapter 78. P804-806

  11. Shakif A (2005) Surgical anatomy of the perineal muscles and their role in perineal disoders. Anatom Sci Intern 80(3):161–171

    Google Scholar 

  12. Shakif A (2005) Perineal rectocele: A common cause of constipation – pathogenesis, clinical presentation and treatment. J Pelv Med Surg 11(4):199–207

    Article  Google Scholar 

  13. Ghetti C, Grerory WT, Edwards SR, Otto LN, Clark AL (2005) Severity of pelvic organ prolapse associated with measurements of pelvic floor function. Int Urogynecol J 16:432–436

    Article  Google Scholar 

  14. Wagenlehner FME, Del Amo E, Santoro GA, Petros P (2013) Live anatomy of the perineal body in patients with third-degree rectocoele. Color Dis 15(11):1416–1422

    Article  CAS  Google Scholar 

  15. Kalis V, Chaloupka P, Turek J, Rokyta Z (2005) The perineal body length and injury at delivery Ceska Gynekol 70(5):355–361

    CAS  Google Scholar 

  16. Tsai PJS, Oyama IA, Hiraoka M, Minaglia S, Thomas J, Kanesshiro B (2012) Perineal body length among different racial groups in the first stage of labor. Fem Pelv Med Reconstruct Surg 18(3):165–167

    Article  Google Scholar 

  17. Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton S (2005) Female genital appearance: “normality” unfolds. BJOG 112:643–646

    Article  PubMed  Google Scholar 

  18. Clark AL, Gregory WT, Smith VJ, Edwards R (2003) Epidemiologic evaluation of re-operation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 189(5):1261–1267

    Article  PubMed  Google Scholar 

  19. Soligo M (2007) Pasterior pelvic floor dysfunction: there is an immediate need to standardize terminology. Int Urogynecol J 18:369–371

    Article  Google Scholar 

  20. Karram MM, Maher C (2013) Surgery for posterior vaginal wall prolapse. Int Urogynecol J 24:1835–1841

    Article  PubMed  Google Scholar 

  21. Lewicky-Gaupp C, Yousuf A, Larson KA, Fenner DE, DeLancey JOL (2010) Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse. Am J Obstet Gynecol 202(5):497

    PubMed Central  PubMed  Google Scholar 

  22. Francis WFA, Jeffcoate TNA (1961) Dyspareunia following vaginal operations. J Obstet Gynaecol Br Commonw 68:1–10

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. St. Vincent’s Clinic, 438 Victoria Street, Darlinghurst, NSW, Australia

    Bernard T. Haylen

  2. St. Vincent’s Hospital, Darlinghurst, NSW, Australia

    Mayada Younis & Sushen Naidoo

  3. Mater Hospital, North Sydney, NSW, Australia

    Warwick Birrell

Authors
  1. Bernard T. Haylen
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  2. Mayada Younis
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  3. Sushen Naidoo
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  4. Warwick Birrell
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Correspondence to Bernard T. Haylen.

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Haylen, B.T., Younis, M., Naidoo, S. et al. Perineorrhaphy quantitative assessment (Pe-QA). Int Urogynecol J 26, 539–544 (2015). https://doi.org/10.1007/s00192-014-2528-1

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  • DOI: https://doi.org/10.1007/s00192-014-2528-1

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