Abstract
Purpose
To assess the subjective and objective outcomes of combined stapled transanal rectal resection (STARR) and urogynecological surgery to treat pelvic organ prolapse, with a 10-year follow-up.
Methods
This was a retrospective cohort study analyzing prospectively collected data from 53 consecutive patients who underwent combined stapled transanal rectal resection and urogynecological surgery, from 1 January 2005 to 31 December 2007 at a tertiary referral Pelvic Floor Unit of an Italian hospital.
Results
Fifty-three patients with a median age of 60 years (interquartile range (IQR) 67–52t), underwent STARR and concomitant urogynecological surgery. No serious postoperative complications were recorded, and 37/53 women (70%) were evaluated at the 10-year follow-up visit. The cure rate was optimal in 34 women (64.1%). Regarding persistent and/or recurrent symptoms, five sexually-active patients (9%) reported dyspareunia only; obstructed defecation symptoms recurred in ten women (19%); urinary incontinence occurred in eight patients (15%); four patients (11%) reported persistent perineal pain; and two patients (5%) experienced both the urge to defecate and voiding dysfunction. At the 10-year follow-up, 14/27 patients (52%) stated that they would undergo the same operation again, if necessary. Furthermore, the survey found that patients would recommend the combined surgery.
Conclusion
The 10-year results of this study proved that combined rectal and urogynecological surgery is well tolerated, associated with low morbidity, and more effectively treats a distressing and debilitating condition vs separate surgeries for rectal and pelvic organ prolapse. We recommend complementing the relatively small scale of this study with randomized trials involving a sufficient number of patients, to provide more conclusive evidence on the cumulative long-term effects of combined surgery vs 2- or 3-stage surgery.
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Data availability
The datasets used and/or analyzed during the current study are available from the Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, Santa Maria dei Battuti Hospital, Conegliano, Treviso, Italy, on reasonable request.
References
Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A et al (2016) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 27(4):655–684
Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ (2008) Pelvic floor disorders network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316
Klingele CJ, Bharucha AE, Fletcher JG, Gebhart JB, Riederer SG, Zinsmeister AR (2005) Pelvic organ prolapse in defecatory disorders. Obstet Gynecol 106(2):315–320
Watadani Y, Vogler SA, Warshaw JS, Sueda T, Lowry AC, Madoff RD, Mellgren A (2013) Sacrocolpopexy with rectopexy for pelvic floor prolapse improves bowel function and quality of life. Dis Colon Rectum 56(12):1415–1422
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506
Boccasanta P, Venturi M, Spennacchio M, Buonaguidi A, Airoldi A, Roviaro G (2010) Prospective clinical and functional results of combined rectal and urogynecologic surgery in complex pelvic floor disorders. Am J Surg 199(2):144–153
Oliveira L, Pfeiffer J, Wexner SD (1996) Physiological and clinical outcome of anterior sphincteroplasty. Br J Surg 83:502–505
Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685
Collinson R, Cunningham C, D’Costa H, Lindsey I (2009) Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study. Colorectal Dis 11:77–83
Marti M-C, Roche B, Déléaval J (1999) Rectoceles: value of videodefaecography in selection of treatment policy. Colorectal Dis 1:324–329
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29(1):4–20. https://doi.org/10.1002/nau.20798
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact Questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn 14:131–139
Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14(3):164–168. https://doi.org/10.1007/s00192-003-1063-2
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J et al (2011) An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J 22(1):3–15
Schiano di Visconte M, Nicolì F, Pasquali A, Bellio G (2018) Clinical outcomes of stapled transanal rectal resection for obstructed defaecation syndrome at 10-year follow-up. Colorectal Dis 20(7):614–662
de Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730
Delorme E (2001) Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 11:1306–1313
Sun Y, Tang C, Luo D, Yang L, Shen H (2016) The treatment of anterior vaginal wall prolapsed by repair with mesh versus colporrhaphy. Int Urol Nephrol 48(2):155–167
Moschowitz AV (1912) The pathogenesis, anatomy, and cure of prolapse of the rectum. Surg Gynecol Obstet 15:7
Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126. https://doi.org/10.1016/0304-3959(86)90228-9
Li M, Jiang T, Peng P, Yang XQ, Wang WC (2015) Association of compartment defects in anorectal and pelvic floor dysfunction with female outlet obstruction constipation (OOC) by dynamic MR defecography. Eur Rev Med Pharmacol Sci 19(8):1407–1415
Guzman Rojas R, Kamisan Atan I, Shek KL, Dietz HP (2016) The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients. Int Urogynecol J 27(6):939–944
Virtanen H, Hirvonen T, Mäkinen J, Kiilholma P (1994) Outcome of thirty patients who underwent repair of posthysterectomy prolapse of the vaginal vault with abdominal sacral colpopexy. J Am Coll Surg 178:283–287
Riansuwan W, Hull TL, Bast J, Hammel JP (2010) Combined surgery in pelvic organ prolapse is safe and effective. Colorectal Dis 12(3):188–192
Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004014.pub5
Melich G, Pai A, Kwak M, Bibi S, Marecik S, Park J et al (2016) Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft insertion: technical details and case series outcomes. Tech Coloproctol 20(1):51–57
Lefevre R, Davila GW (2008) Functional disorders: rectocele. Clin Colon Rectal Surg 21(2):129–137
Rehman H, Bezerra CC, Bruschini H, Cody JD (2011) Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev 1:CD001754
Ganj FA, Ibeanu OA, Bedestani A, Nolan TE, Chesson RR (2009) Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct 20(8):919–925
Sullivan ES, Longaker CJ, Lee PY (2001) Total pelvic mesh repair: a ten-year experience. Dis Colon Rectum 44:857–863
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MSDV: protocol/project development, data collection, data analysis, manuscript writing. read, critically revised, and approved the final manuscript. AA: data collection, data analysis, manuscript writing. read, critically revised, and approved the final manuscript.
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Schiano di Visconte, M., Azzena, A. A 10-year retrospective cohort study to assess objective and subjective outcomes of combined stapled transanal rectal resection and urogynecological surgery for pelvic floor dysfunction. Arch Gynecol Obstet 302, 393–404 (2020). https://doi.org/10.1007/s00404-020-05605-3
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DOI: https://doi.org/10.1007/s00404-020-05605-3