Cystocele and rectocele repair with native tissue layers: definition of the technique
Abstract
Objectives: To investigate the outcomes of central cystocele and rectocele repair using natural tissue layers. To describe a novel technique (Dogan technique). Material and methods: This is a retrospective cohort study. Between January 2021 and January 2023, patients who had central cystocele and rectocele higher than stage1 were included in the study. The Pelvic Organ Prolapse Quantification (POP-Q) score was used to determine the degree of the prolapsus. All cystocele and rectocele repair surgeries were performed by the same physician. The patients' voiding habits were assessed using ICIQ-SF and OAB-V8. Sexual function results were assessed with FSFI questionnaire before and after the operation. Transperineal ultrasonography was performed to examine mobility of the anterior and posterior compartments. Results: Total of 36 patients were diagnosed with grade 2 and above central cystocele (19, 52%) and rectocele (n = 17, 48%). After the operation the anatomical cure of anterior and posterior compartments was achieved for all patients in the two-years follow-up. According to voiding habits before the surgery, there were symptoms of stress urinary incontinence (SUI),urge urinary incontinence (URGE), both SUI and URGE, and no incontinence at the patients; 7 (36.8%), 14 (73.7%), 5 (26.3%), 3 (15.7%) respectively. Of those URGE patients (n = 5/14, 35.7%) incontinence symptoms were mixed-type. After the cystocele operation, significant improvement was seen in their voiding problems according to the ICIQ-SF and OAB-V8 questionnaires (p < 0.05). As well as significant improvement was found in sexual function according to the FSFI questionnaire (p < 0.05). Conclusions: We showed that strengthening the anterior and/or posterior compartments with native tissue improves urge and voiding dysfunctions via a novel technique (Dogan technique) without removing the vagina tissue.
Keywords: cystocelerectoceleSIUURGEhammock theoryPOP-Q
References
- Beck RP, McCormick S, Nordstrom L. A 25-year experience with 519 anterior colporrhaphy procedures. Obstet Gynecol. 1991; 78(6): 1011–1018.
- Safir MH, Gousse AE, Rovner ES, et al. 4-Defect repair of grade 4 cystocele. J Urol. 1999; 161(2): 587–594.
- Mourtialon P, Letouzey V, Eglin G, et al. French Ugytex Study Group. Cystocele repair by vaginal route: comparison of three different surgical techniques of mesh placement. Int Urogynecol J. 2012; 23(6): 699–706.
- Kelly HA, Dumm WM. Urinary incontinence in women, without manifest injury to the bladder. 1914. Int Urogynecol J Pelvic Floor Dysfunct. 1998; 9(3): 158–164.
- Sand PK, Koduri S, Lobel RW, et al. Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol. 2001; 184(7): 1357–62; discussion 1362.
- Norton PA. Pelvic floor disorders: the role of fascia and ligaments. Clin Obstet Gynecol. 1993; 36(4): 926–938.
- Leanza V, Intagliata E, Leanza G, et al. Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique. G Chir. 2013; 34(11-12): 332–336.
- Swift S, Morris S, McKinnie V, et al. Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17(6): 615–620.
- Tarcan T, Mangır N, Özgür MÖ, et al. OAB-V8 AAM Sorgulama Formu Validasyon Çalıması Üroloji Bülteni. 2012; 21: 113–116.
- Çetinel B, Özkan B, Can G. ICIQ-SF Türkçe versiyonu validasyon (geçerlilik) çalışması. Türk Üroloji Dergisi. 2004; 30(3): 332–338.
- Aygin, D. ve Eti Aslan, F. . Kadın Cinsel İşlev Ölçeği'nin Türkçeye Uyarlaması. Turkiye Klinikleri J Med Sci. 2005; 25(3): 393–399.
- Shek KL, Dietz HP. Assessment of pelvic organ prolapse: a review. Ultrasound Obstet Gynecol. 2016; 48(6): 681–692.
- Dietz HP, Lekskulchai O. Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms. Ultrasound Obstet Gynecol. 2007; 29(6): 688–691.
- Hung MJ, Liu FS, Shen PS, et al. Factors that affect recurrence after anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15(6): 399–406; discussion 406.
- Duraisamy KY, Balasubramaniam D, Kakollu A, et al. A Prospective Study of Minimally Invasive Paravaginal Repair of Cystocele and Associated Pelvic Floor Defects: Our Experience. J Obstet Gynaecol India. 2019; 69(1): 82–88.
- Sahin F, Adan R, Emeklioglu CN, et al. The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT). Sisli Etfal Hastan Tip Bul. 2023; 57(4): 500–505.
- Naranjo-Ortiz C, Shek KaL, Martin AJ, et al. What is normal bladder neck anatomy? Int Urogynecol J. 2016; 27(6): 945–950.
- Szymanowski P, Banach P, Wisniewski A, et al. The impact of cystocele repair on urge symptoms in women with pelvic organ prolapse. Ginekol Pol. 2022 [Epub ahead of print].
- Petros P, Ulmsten U. An Integral Theory of Female Urinary Incontinence. Acta Obstet Gynecol Scand. 1990; 69(Suppl 153): 7–31.
- Kuo HC. Measurement of detrusor wall thickness in women with overactive bladder by transvaginal and transabdominal sonography. Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20(11): 1293–1299.
- Lensen EJM, Withagen MIJ, Kluivers KB, et al. Surgical treatment of pelvic organ prolapse: a historical review with emphasis on the anterior compartment. Int Urogynecol J. 2013; 24(10): 1593–1602.
- Maher CM, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J. 2011; 22(11): 1445–1457.
- Jia X, Glazener C, Mowatt G, et al. Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG. 2008; 115(11): 1350–1361.
- Moore RD, Miklos JR. Vaginal repair of cystocele with anterior wall mesh via transobturator route: efficacy and complications with up to 3-year followup. Adv Urol. 2009; 2009: 743831.
- Nüssler E, Kesmodel U, Löfgren M, et al. Operation for primary cystocele with anterior colporrhaphy or non-absorbable mesh: patient-reported outcomes. International Urogynecology Journal. 2014; 26(3): 359–366.
- Turgal M, Sivaslioglu A, Yildiz A, et al. Anatomical and functional assessment of anterior colporrhaphy versus polypropylene mesh surgery in cystocele treatment. Eur J Obstet Gynecol Reprod Biol. 2013; 170(2): 555–558.
- Menefee SA, Dyer KY, Lukacz ES, et al. Colporrhaphy compared with mesh or graft-reinforced vaginal paravaginal repair for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol. 2011; 118(6): 1337–1344.
- Altman D, Väyrynen T, Engh ME, et al. Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011; 364(19): 1826–1836.
- Vergeldt TFM, Notten KJB, Weemhoff M, et al. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study. BJOG. 2015; 122(8): 1130–1137.
- Abramov Y, Gandhi S, Goldberg RP, et al. Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol. 2005; 105(2): 314–318.
- Sung V, Rardin C, Raker C, et al. Porcine Subintestinal Submucosal Graft Augmentation for Rectocele Repair. Obstetrics & Gynecology. 2012; 119(1): 125–133.
- Shahghaibi S, Faizi S, Gharibi F. Effect of colporrhaphy on the Sexual Dysfunction of women with pelvic organ prolapsed. Pak J Med Sci. 2013; 29(1): 157–160.
