Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy.
BACKGROUND
This study was conducted to investigate the results of rectovaginovesicopexy (RVVP) in patients with combined defaecation and micturition disorders. RVVP was developed from a standard procedure for different forms of defaecation disorders (the rectovaginopexy (RVP)). It is only a limited extension to the RVP and results in elevation of all three pelvic compartments.


METHODS
In a consecutive series of 25 patients the effects or RVVP were evaluated prospectively. Information about the clinical history and results was obtained by a standard questionnaire filled out before and 3 and 12 months after operation. Dynamic defaecography was performed before and 3 months after RVVP. Before operation urodynamic studies were conducted.


RESULTS
RVVP improved constipation (14 of 18 patients improved, P = 0.001), faecal incontinence (11 of 16 patients improved, P = 0.005) and dysfunctional voiding (ten of 16 patients improved, P = 0.07) without induction of these disorders. Overall urinary incontinence improved in 11 of 22 patients (P = 0.18), with deterioration of urinary incontinence in three and induction of urinary incontinence in two of the patients. Patients with isolated urinary stress incontinence fared better (eight of 13 patients improved) than those with mixed urinary incontinence.


CONCLUSIONS
RVVP provides satisfactory improvement of combined defaecation and micturition disorders. The benefits of a limited extension of the RVP seem to outweigh potential side-effects such as deterioration or de novo defaecation or micturition disorders.
Silvis
R
R
Department of Surgery, University Hospital Utrecht, The Netherlands.
Gooszen
H G
HG
Kahraman
T
T
Groenendijk
A G
AG
Lock
M T
MT
Italiaander
M V
MV
Janssen
L W
LW
D000328:Adult; D000368:Aged; D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome; D014555:Urination Disorders / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014621:Vagina / Q000601:surgery
D011138:Polytetrafluoroethylene