Rectocele: Correlation Between Defecography and Physical Examination.

Autor:	Crowder CA; From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, UC Irvine., Sayegh N; Biological Sciences, University of California, Irvine., Guaderrama NM; Southern California Permanente Medical Group, Irvine, CA., Jeney SES; Division of Urogynecology, University of New Mexico, Department of Obstetrics and Gynecology, Albuquerque, NM., Buono K; Urogynecology Consultants Medical Group, Sacramento., Yao J; Clinical Informatics and Research Databases, Southern California Permanente Medical Group, Pasadena CA., Whitcomb EL; Southern California Permanente Medical Group, Irvine, CA.
Jazyk:	angličtina
Zdroj:	Urogynecology (Philadelphia, Pa.) [Urogynecology (Phila)] 2023 Jul 01; Vol. 29 (7), pp. 617-624. Date of Electronic Publication: 2023 Jan 23.
DOI:	10.1097/SPV.0000000000001330
Abstrakt:	Importance: There is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse. Objectives: The aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes. Study Design: This was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable. Results: One hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59-11.34; P < 0.01) as was advanced PVWP stage ( P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms ( P = 0.02). Conclusions: We demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not. Competing Interests: The authors have declared they have no conflicts of interest. (Copyright © 2023 American Urogynecologic Society. All rights reserved.)
Databáze:	MEDLINE
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