RESUMO
BACKGROUND: Rectocele is a herniation of the anterior wall of the rectal ampulla through a defect in the rectovaginal septum causing protrusion of the posterior vaginal wall. Common symptoms include symptoms of prolapse and obstructed defecation. AIMS: To describe subjective, anatomical and functional results of defect-specific rectocele repair. MATERIALS AND METHODS: This is an internal audit of 137 women who underwent defect-specific rectocele repair. Pre- and post-operative assessment included a standardised interview, clinical examination and 3D/4D transperineal ultrasound. Outcome measures were symptoms of obstructed defecation, recurrent prolapse symptoms, clinical posterior compartment recurrence and rectocele recurrence on ultrasound. RESULTS: At a mean follow-up of 1.4 years, 117 (85%) of women considered themselves cured or improved. Thirty-four (25%) complained of recurrent prolapse symptoms and 47 (34%) symptoms of obstructed defecation, a significant reduction (P < 0.0001). Clinical recurrence (Bp ≥ -1) was seen in 19 women (14%) and recurrence on ultrasound in 27 (20%). The mean depth of recurrence was 16.6 mm (10.3-25.1). We tested multiple potential predictors of recurrence, including age, BMI, vaginal parity, previous hysterectomy and/or prolapse surgery, follow-up time, pre-operative clinical and ultrasound findings. Only hiatal area on Valsalva (OR 0.95 for sonographic recurrence, P = 0.01) and enterocele (for clinical and sonographic recurrence, OR 4.03, P = 0.01 and OR 2.72, P = 0.02, respectively) reached significance. CONCLUSION: Defect-specific rectocele repair is effective both in restitution of normal anatomy and in resolving prolapse and obstructed defecation symptoms at a mean follow-up of 1.4 years.
Assuntos
Imageamento Tridimensional , Avaliação de Resultados da Assistência ao Paciente , Retocele/diagnóstico por imagem , Retocele/cirurgia , Prolapso Uterino/cirurgia , Adulto , Idoso , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Razão de Chances , Satisfação do Paciente/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/métodos , Retocele/complicações , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Resultado do Tratamento , Ultrassonografia , Prolapso Uterino/diagnóstico por imagem , Prolapso Uterino/etiologiaRESUMO
OBJECTIVES: To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma. METHODS: This was a retrospective analysis of ultrasound volume datasets of 501 patients attending a tertiary urogynecological unit. All patients underwent a standardized interview including determination of St Mark's score for those presenting with AI. Tomographic ultrasound imaging (TUI) was used to evaluate the EAS and the internal anal sphincter (IAS). RESULTS: Among a total of 501 women, significant EAS and IAS defects were found in 88 and 59, respectively, and AI was reported by 69 (14%). Optimal prediction of AI was achieved using a model that included four abnormal slices of the EAS on TUI. IAS defects were found to be less likely to be associated with AI. In a multivariable model controlling for age and IAS trauma, the presence of at least four abnormal slices gave an 18-fold (95% CI, 9-36; P < 0.0001) increase in the likelihood of AI, compared with those with fewer than four abnormal slices. Using receiver-operating characteristics curve statistics, this model yielded an area under the curve of 0.86 (95% CI, 0.80-0.92). CONCLUSIONS: Both AI and significant EAS trauma are common in patients attending urogynecological units, and are strongly associated with each other. Abnormalities of the IAS seem to be less important in predicting AI. Our data support the practice of using, as a minimal criterion, defects present in four of the six slices on TUI for the diagnosis of significant EAS trauma.
Assuntos
Canal Anal/lesões , Incontinência Fecal/etiologia , Complicações do Trabalho de Parto/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/diagnóstico por imagem , Incontinência Fecal/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Prevalência , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Tomografia , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence of obstetric anal sphincter injuries (OASIS) in a cohort of primiparous women and to evaluate their association with demographic, obstetric and ultrasound parameters. METHODS: This was a retrospective analysis of the ultrasound volume datasets of 320 primiparous women, acquired at 5 months postpartum. Tomographic ultrasound imaging (TUI) was used to evaluate the external anal sphincter (EAS). A significant EAS defect was diagnosed if a defect of > 30° was seen in four or more of six TUI slices bracketing the EAS. RESULTS: Significant EAS defects were found in 69 women (27.9% of those delivered vaginally). In nine of those a third-degree tear was diagnosed intrapartum and was sutured. In 60 women with significant defects there was no documentation of sphincter damage at birth, implying unidentified or occult defects (60/69, 87.0%). Among them, 29 had had a second-degree tear, two a first-degree tear and three an intact perineum. In 31 cases an episiotomy had been performed, with five extensions to a third-degree tear. On multivariate analysis only forceps delivery was significantly associated with OASIS. CONCLUSIONS: In this cohort of primiparous women we found OASIS in 27.9% of vaginally parous women, most of which had not been diagnosed in the delivery suite. There seems to be a need for better education of labor-ward staff in the recognition of OASIS. On the other hand, it is conceivable that some defects may be masked by intact tissue. The significance of such defects remains doubtful. Forceps delivery was the only identifiable risk factor.
Assuntos
Canal Anal/lesões , Complicações do Trabalho de Parto/etiologia , Adolescente , Adulto , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/etiologia , Feminino , Humanos , Lacerações/etiologia , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/diagnóstico por imagem , Paridade , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Ultrassonografia , Adulto JovemRESUMO
We report a clinical case in which an early ultrasound diagnosis of retained abortion of thoracoomphalopagus siamese twins is performed by embryonic biometry at 9.5 weeks of gestation. 2D and 3D images clearly illustrate the condition and the accuracy of prompt diagnosis of a disease with such a low prevalence among the world population.
Se reporta caso clínico en el cual se realiza el diagnóstico ecográfico precoz de aborto retenido de siameses tóraco onfalópagos de 9 1/2 semanas por biometría embrionaria. Destacables son las imágenes 2D y 3D que ilustran claramente la condición y la precocidad del diagnóstico de una patología tanpoco prevalente en la población mundial.