title: Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial.
abstract: OBJECTIVE
  To estimate the effect of porcine subintestinal submucosal graft augmentation on improving anatomic and subjective rectocele repair outcomes compared with native tissue repair.
  
  
  METHODS
  We conducted a randomized controlled trial at two sites, including women with at least stage 2 symptomatic rectocele. Anatomic and subjective outcomes (vaginal bulge and defecatory) were collected 12 months postoperatively, including blinded Pelvic Organ Prolapse Quantification (POP-Q) examinations. Anatomic failure was defined as points Ap or Bp -1 or greater on POP-Q. Subjective failure was defined as no improvement or worsening of symptoms. We estimated number needed to treat and adjusted odds ratios (ORs). Assuming graft use is associated with 93% anatomic success, 63 women per group would be needed to detect a 20% difference at α=.05 and β=.20.
  
  
  RESULTS
  One hundred sixty women were randomized; 137 had 12-month anatomic data (67 graft; 70 control). There was no difference in anatomic failure (12% compared with 9%, P=.5), vaginal bulge symptom failure (3% compared with 7%, P=.4, number needed to treat=26) or defecatory symptom failure (44% compared with 45%, P=.9, number needed to treat=91) for graft compared with control, respectively. Both groups reported improvement in vaginal bulge and defecatory symptoms (P<.05 for all). On multiple logistic regression, graft use was not associated with a decreased odds of anatomic failure (adjusted OR 1.36, 95% confidence interval [CI] 0.44-4.25), vaginal bulge symptoms (adjusted OR 0.46, 95% CI 0.08-2.68), or defecatory symptoms (adjusted OR 0.98, 95% CI 0.48-2.03).
  
  
  CONCLUSIONS
  Although rectocele repair by either approach is associated with improved symptoms, subintestinal submucosal graft augmentation was not superior to native tissue for anatomic or subjective outcomes at 12 months.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT00321867.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, Alpert Medical School of Brown University, and Department of Obstetrics and Gynecology, Division of Research, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA. vsung@wihri.org
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Sung
authors.forename: Charles R
authors.initials: CR
authors.lastname: Rardin
authors.forename: Christina A
authors.initials: CA
authors.lastname: Raker
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lasala
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Myers
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001705:Bioprosthesis; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D020047:Rectocele / Q000601:surgery*; D013552:Swine; D054457:Tissue Scaffolds; D016896:Treatment Outcome