Assessing Rectocele Depth and Its Association with Symptoms of Pelvic Floor Disorders Using 2D Transperineal Ultraound

정홍윤,이종균 대한외과초음파학회 2022 대한외과초음파학회지 Vol.9 No.2

We investigated the clinical features of symptomatic rectoceles, as measured by transperineal ultrasound (TPUS), and evaluated the association between rectocele size and the clinical symptoms of pelvic floor disorders. This was a retrospective study using data obtained at a pelvic floor center between August 2020 and January 2021. A total of 125 patients with defecation disorders, such as constipation and fecal incontinence, were included. The preoperative questionnaire included the Cleveland Clinic Constipation Scoring System (CCCS, Wexner constipation score), Cleveland Clinic Incontinence Score (CCIS, Wexner incontinence score), fecal incontinence severity index (FISI), and fecal incontinence quality of life (FIQOL) scale. The size of the rectocele was measured on 2D-TPUSimages. Patients were assigned to three groups based on rectocele size: no rectocele (<10 mm), ≥10 mm rectocele, and ≥15 mm rectocele. In the study population, 43 participants (34.4%) had no rectocele, 50 (40.0%) had ≥10 mm rectocele, and 32 (25.6%) had ≥15 mm rectocele. With the increase in the size of the rectocele from the no rectocele to ≥15 mm rectocelegroup, the scores for the symptoms of incontinence and constipation increased, and the quality of life worsened. The increase in the scores for the three groups was as follows: CCIS (6.00 ± 4.95 vs. 8.62 ± 5.77 vs. 11.08 ± 5.63, P = 0.004), FIQOL (13.72 ± 4.19 vs. 13.42 ± 4.35 vs. 10.38 ± 3.88, P = 0.006), FISI (18.83 ± 17.67 vs. 25.15 ± 17.34 vs. 33.42 ± 15.49, P = 0.010), and CCCS (7.50 ± 6.26 vs. 8.65 ± 5.31 vs. 13.11 ± 5.90, P = 0.006), respectively. TPUS is a valuable method for the anatomical evaluation of symptomatic rectocele. The larger the size of the symptomatic rectocele measured using TPUS, the more severe were the clinical symptoms.

직장탈출증후군의 병인과 외과적 치료

김진천,김창남,박상규,김숙영,유창식 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.2

직장류 환자에서 직장 항문 기능검사의 특성과 임상적 의미

김석균,박웅채 대한대장항문학회 1996 Annals of Coloproctolgy Vol.12 No.1

Transperineal rectocele repair is ideal for patients presenting with fecal incontinence

De Robles Marie Shella,Young Christopher J. 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.5

Purpose: Rectocele can be associated with both obstructed defecation and fecal incontinence. There exists a great variety of operative techniques to treat patients with rectocele. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele when presenting with fecal incontinence as the predominant symptom. Methods: Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon. Results: All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range, 21–90 years). None were fully continent preoperatively. However, continence improved to just rare mucus soiling or loss of flatus in all patients 6 months after their surgery. There was no operative mortality. Postoperative complications including urinary retention and wound dehiscence occurred in 3 patients. Conclusion: Fecal incontinence associated with rectocele is multifactorial and may be caused by preexisting anal sphincteric damage and attenuation. Our experience suggests that transperineal repair provides excellent anatomic and physiologic results with minimal morbidity in selected patients presenting with combined rectocele and anal sphincter defect.

Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation

Süleyman Büyükaşık,Mehmet Abdussamet Bozkurt,Selin Kapan,Halil Alis 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.5

Purpose: Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation.Methods: Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into 2 groups based on presence of rectocele. Both groups’ anal sphincter pressures were evaluated using anal manometry and findings were compared.Results: The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume, and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P > 0.05).Conclusion: We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures.

배변조영소견에 의한 직장류의 유의성 판정

성무경,선관우 대한대장항문학회 1996 Annals of Coloproctolgy Vol.12 No.4

직장류 환자를 위한 경항문 직장류 교정술 단독 술식과 후질벽봉합술을 더한 복합술식에서 항문직장 기능 변화와 치료성적의 비교

김주형,권영민,이용표 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.2

Mucopexy-Recto Anal Lifting (MuRAL) in managing obstructed defecation syndrome associated with prolapsed hemorrhoids and rectocele: preliminary results

Claudio Pagano,Marco Venturi,Guido Benegiamo,Ernesto Melada,Contardo Vergani 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.5

Purpose: Treatment of rectocele associated with prolapsed hemorrhoids is a debated topic. Transanal stapling achieved good midterm results in patients with symptoms of obstructed defecation, nevertheless a number of severe complications have been reported. The aim of this study was to evaluate the safety and efficacy of a new endorectal manual technique in patients with obstructed defecation due to the combination of muco-hemorrhoidal prolapse and rectocele. Methods: Patients enrolled after preoperative obstructed defecation syndrome (ODS) score, defecography and anoscopy were submitted to the novel Mucopexy-Recto Anal Lifting (MuRAL) combined with a modified Block procedure, and followed up by independent observers with digital exploration 3 weeks postoperatively, and digital exploration plus anoscopy at 3, 6, and 12 months. Operative time, hospital stay, numerating rating scale (NRS), ODS, satisfaction scores, and recurrence rate were recorded. Results: Mean operative time was 35.7 minutes. Fifty-six patients completed 1-year follow-up: 7.1% had acute urinary retention, NRS score was < 3 from the third postoperative day, mean time of daily activity resumption was 12 days, none had persistent fecal urgency, 82% declared excellent/good satisfaction score, significant improvement of 6- and 12-month ODS score, no recurrence of rectocele, and 7.1% recurrence of prolapsed hemorrhoids were observed. Conclusion: MuRAL associated with modified Block technique gave no severe complications and resulted in a safe and effective approach to symptomatic rectocele associated with muco-rectal prolapse. Further randomized studies, larger series, and longer follow-up are needed.

직장류 환자에 대한 바이오피드백 치료

김봉수,황용희,최건필 대한대장항문학회 2001 Annals of Coloproctolgy Vol.17 No.2

Factors Predicting the Presence of Concomitant Enterocele and Rectocele in Female Patients With External Rectal Prolapse

Akira Tsunoda,Tomoko Takahashi,Kenji Sato,Hiroshi Kusanagi 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.4

Purpose: External rectal prolapse (ERP) is frequently associated with other pelvic disorders, such as enterocele, rectocele, and perineal descent. Evacuation proctography makes it possible to visualize the development of such anatomical abnormalities. The aim of this study was to identify the variables that would predict associated abnormalities in patients with ERP.Methods: Between February 2010 and August 2019, 124 female patients with ERP, who were evaluated using proctography were included in this study. Enterocele was diagnosed when the extension of the loop of the small bowel was located between the vagina and rectum. A significant rectocele was defined as >20 mm in diameter. Multivariate analysis was used to establish which morphological parameters best predicted the presence of enterocele or rectocele.Results: Sixty-five patients had ERP alone, while 59 patients (47.6%) had additional findings on proctography. The most frequently associated abnormality was enterocele with 48 of the patients (38.7%) having this condition. Rectocele was detected in 17 of the 124 patients (13.7%). The median length of the ERP was 30 mm (range, 7 to 147 mm). The results of the stepwise multiple regression analysis showed that a history of hysterectomy and the length of the ERP were significantly associated with the presence of enterocele. The analysis showed that the longer the prolapse, the higher the incidence of enterocele. A history of hysterectomy was also significantly associated with the presence of rectocele.Conclusion: Patients with ERP often have associated anatomical abnormalities and should be investigated thoroughly before planning surgical treatment.