title: Measuring the impact of a posterior compartment procedure on symptoms of obstructed defecation and posterior vaginal compartment anatomy.
abstract: OBJECTIVE
  We hypothesized that there would be a significant difference in changes in obstructed defecation symptoms and posterior compartment prolapse between women who underwent posterior vaginal wall prolapse repair (PR) and those who did not.
  
  
  METHODS
  This was a two-site prospective cohort study of women undergoing prolapse or incontinence surgery in which a PR was, or was not, performed at the discretion of the surgeon. Women were assessed using validated obstructed defecation questionnaires and standardized examination measures (including POP-Q, measurement of transverse gh, and assessment for a rectovaginal pocket and laxity) prior to pelvic surgery and 12 weeks after surgery.
  
  
  RESULTS
  Of 68 women who underwent surgery, 43 had PR. The PR group had higher obstructed defecation symptoms and greater posterior compartment prolapse at baseline. At 12 weeks, obstructed defecation symptoms had improved significantly more in the PR group than in the no PR group (all p < 0.03). Anatomic outcomes showed greater improvement in point Bp in the PR group (-3.4 vs. -0.7 no PR, p < 0.001) and resolution of the rectovaginal pocket (86 % vs. 42 %, p = 0.002). There were no significant changes in obstructed defecation symptoms or anatomic outcomes from baseline in the no PR group, while the PR group showed significantly improved obstructed defecation symptoms and anatomic outcomes after repair (p < 0.001 for both).
  
  
  CONCLUSIONS
  Significant improvements in obstructed defecation symptoms and posterior compartment prolapse were seen after PR, but not in women who did not receive PR. Obstructed defecation symptoms, Bp and rectovaginal pocket were the measures best able to demonstrate improvement after PR. We recommend the use of these measures to assess the impact of surgery in the posterior compartment.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16, Room 127, New York, NY, 10032, USA. clg2173@columbia.edu.
authors.forename: Cara L
authors.initials: CL
authors.lastname: Grimes
authors.affiliation: San Diego Clinical and Translational Research Institute, UC San Diego Health System, San Diego, CA, USA.
authors.forename: Rosanna H
authors.initials: RH
authors.lastname: Overholser
authors.affiliation: Department of Family and Preventive Medicine and Department of Mathematics, UC San Diego Health System, San Diego, CA, USA.
authors.forename: Ronghui
authors.initials: R
authors.lastname: Xu
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Tan-Kim
authors.affiliation: Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Nager
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA.
authors.forename: Keisha Y
authors.initials: KY
authors.lastname: Dyer
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA.
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Menefee
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA.
authors.forename: Gouri B
authors.initials: GB
authors.lastname: Diwadkar
authors.affiliation: Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Lukacz
mesh_terms: D000328:Adult; D000368:Aged; D003672:Defecation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011446:Prospective Studies
keywords: Anatomic measures; Obstructed defecation; Posterior repair; Rectocele; Symptom measures