title: Functional outcomes of posterior vaginal wall repair and prespinous colpopexy with biological small intestinal submucosal (SIS) graft.
abstract: OBJECTIVE
  Surgical management of posterior vaginal wall prolapse has variable functional outcomes. Synthetic and biological grafts are used to improve outcomes and reduce failures. The objective of this study was to determine the functional outcomes and its implications on patient-reported quality of life of a technique of posterior vaginal wall repair and prespinous colpopexy with biological small intestinal submucosal (SIS) graft in the management of posterior vaginal wall prolapse.
  
  
  METHODS
  This prospective cohort study was conducted in a urogynaecology subspecialty center in the UK. Women with moderate degree rectocele or more, with or without other compartmental prolapse underwent posterior vaginal wall repair and prespinous colpopexy with SIS graft over a 3-year period. ICIQ vaginal symptoms questionnaires were used pre-operatively and at 6 months post-operatively to assess functional outcomes. The Wilcoxon signed R test was used to analyze the results.
  
  
  RESULTS
  50 women underwent posterior repair with SIS graft (27 with concomitant procedures). There was a statistically significant improvement (p < 0.0001) in the vaginal symptoms and sexual matters scores at 6-month follow-up in all the women. The quality of life scores also improved significantly (p < 0.0001) in all the women. Concomitant pelvic surgery did not affect the outcomes (p < 0.0001). There were no significant intra- or post-operative complications.
  
  
  CONCLUSIONS
  Posterior vaginal wall repair and prespinous colpopexy with biological SIS graft is an effective surgical option for managing women with posterior vaginal wall prolapse with or without other concomitant compartmental defects.
authors.affiliation: Department of Urogynaecology, Gloucester Royal Hospital, Great Western Rd, Gloucester, GL1 3NN, UK, drmadhuck@gmail.com.
authors.forename: Chendrimada
authors.initials: C
authors.lastname: Madhu
authors.forename: Joanna
authors.initials: J
authors.lastname: Cooke
authors.forename: Penelope
authors.initials: P
authors.lastname: Harber
authors.forename: David
authors.initials: D
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000601:surgery*; D008875:Middle Aged; D011788:Quality of Life; D020047:Rectocele / Q000601:surgery; D011795:Surveys and Questionnaires; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*