title: A three-year prospective assessment of rectocele repair using porcine xenograft.
abstract: OBJECTIVE
  To prospectively evaluate clinical outcome of rectocele repair using xenograft 3 years after surgery.
  
  
  METHODS
  Twenty-three patients who completed evaluation preoperatively and 1 year after surgery were assessed at a 3-year follow-up. Clinical examination was performed preoperatively, and at the 1- and 3-year follow-ups, with the pelvic organ prolapse quantification system. Symptom assessment was performed with a validated bowel function questionnaire including questions on sexual function.
  
  
  RESULTS
  There were no graft-related complications during the 3 years following surgery. Preoperatively, all patients had stage II prolapse of the posterior vaginal wall and a rectocele verified at defecography. At the 1-year follow-up, 11 of 29 patients (38%) had rectocele of stage II or more, and 4 patients were reoperated. At 3-year follow-up 7 of 23 patients (30%) had rectocele of stage II or more. When including the 4 early anatomical recurrences, a total of 11 of 27 patients (41%) had rectocele of stage II or more at 3-year follow-up. Preoperatively, all patients reported varying degrees of rectal emptying difficulties and symptoms of bowel dysfunction. There was a significant decrease in rectal emptying difficulties (P < .01), sense of incomplete evacuation (P < .01), need for manually assisted defecation (P < .05), and symptoms of pelvic heaviness (P < .001) at the 3-year follow-up compared with preoperatively. Cure of rectal emptying difficulties was reported by fewer than 50% of patients. There were no significant changes in anal incontinence scores or symptoms of sexual dysfunction at the 3-year follow-up compared with preoperatively.
  
  
  CONCLUSIONS
  Rectocele repair using porcine dermal graft was associated with an unsatisfactory anatomical cure rate and persistent bowel-emptying difficulties in the majority of patients 3 years postoperatively.
  
  
  METHODS
  II-3.
authors.affiliation: Pelvic Floor Center Danderyd Hospital, Division of Obstetrics and Gynecology, Stockholm, Sweden. daniel.altman@ds.se
authors.forename: Daniel
authors.initials: D
authors.lastname: Altman
authors.forename: Jan
authors.initials: J
authors.lastname: Zetterström
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
authors.forename: Catharina
authors.initials: C
authors.lastname: Gustafsson
authors.forename: Bo
authors.initials: B
authors.lastname: Anzén
authors.forename: Annika
authors.initials: A
authors.lastname: López
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D003113:Colonoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D020047:Rectocele / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013552:Swine; D013997:Time Factors; D014183:Transplantation, Heterologous; D017211:Treatment Failure; D016896:Treatment Outcome