Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?
OBJECTIVE
The aim of the study was to report anatomic and functional outcome of midline fascial plication under continuous digital transrectal control and to identify predictors of anatomic failure.


METHODS
Prospective observational cohort. Anatomic success defined as POP-Q stage <or= I of the posterior compartment. Validated questionnaires to measure bother and impact on quality of life. Logistic regression to identify risk factors for anatomic failure.


RESULTS
Two hundred thirty-three patients with posterior pelvic organ prolapse (POP) stage >or= II underwent midline fascial plication under continuous digital transrectal control. Median follow-up was 14 months (12-35 months), and anatomic success was 80.3% (95% CI 75-86). Independent predictors of failure were posterior compartment POP stage >or= III [OR 8.7 (95% CI 2.7-28.1)] and prior colposuspension [OR 5.6 (95% CI 1.1-27.8)]. Sixty-three percent of patients bothered by obstructed defaecation experienced relief after surgery.


CONCLUSIONS
Anatomic and functional outcomes were good. Risk factors for anatomic failure were initial size of posterior POP (stage >or= III) and prior colposuspension.
Department of Obstetrics and Gynaecology, Reinier de Graaf Group, PO Box 5011, 2600, GA Delft, The Netherlands. almilani@telfort.nl
Alfredo L
AL
Milani
Mariella I J
MI
Withagen
Karlijn J
KJ
Schweitzer
Erica W M
EW
Janszen
Mark E
ME
Vierhout
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000209:etiology; D004414:Dyspareunia / Q000209:etiology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D014621:Vagina / Q000601:surgery*; D055815:Young Adult