Lucia Morganti1, Francesca Gubbiotti1, Simona Ascanelli1, Ruby Martinello2, Gennaro Scutiero2, Giorgio Cremonini2,
Pantaleo Greco2
1Clinica Chirurgica, Università degli Studi di Ferrara
2Clinica Ostetrica e Ginecologica, Università degli Studi di Ferrara
Topic: Disfunzioni complesse del pavimento pelvico
Purpose: To evaluate clinical outcomes and quality of life (QoL) in patients with complex pelvic floor disorders (PFDs) treated by
a multidisciplinary group with anterior or posterior vaginal wall repair with or without vaginal hysterectomy (VAHY) associated to stapled trans-anal
rectal resection (STARR).
Methods: Retrospective cohort study including all patients with complex PFDs managed by a multidisciplinary and interprofessional pelvic
floor team, receiving combined STARR and uro-gynecologic surgery at our institution over a two-year period. Patient’s clinical outcomes and QoL before
and after the combined surgical treatment was evaluated by submitting Pelvic Floor Disorders Distress Inventory (PFDI) and Pelvic Floor Disorders Impact
Questionnaire (PFIQ), respectively. For functional evaluation, preoperative and postoperative obstructed defecation syndrome scores and anorectal manometry
were employed.
Results: Between December 2012 and December 2014, 18 consecutive patients underwent combined STARR and anterior or posterior vaginal
wall repair with or without VAHY. PFDI, PFIQ and obstructed defecation syndrome scores were all improved after combined surgical repair (p <0,0001)
(Table 1). At postoperative anorectal manometry, rectal compliance increased (p=0.03) while mean resting pressure and squeeze pressure did not vary significantly
(Table 2). No patients required re-operation at 22-month follow up, while one patient had a prolapse recurrence one year after the operation.
Conclusions: These preliminary data support the multidisciplinary interprofessional management of complex PFDs to achieve good clinical
outcomes and QoL in patients undergoing trans-perineal surgery. A multidisciplinary approach may help the decision-making process for
complex PFDs and may reduce single-specialist management failure.
Table 1. The clinical outcomes and health-related QoL of patients with complex PFDs who underwent combined surgical repair by a multidisciplinary
team.
|
Before Surgery |
After Surgery |
p |
Pelvic Floor Distress Inventory – PFDI (range 0-300) |
170.6 (163.5-192.7) |
88.0 (68.8-123.7) |
<0.0001 |
Pelvic Organ Prolapse Quantification – POP-Q (grade 0-4) |
2.0 (2.0-3.0) |
0 (0-1.0) |
<0.0001 |
Obstructed Defecation Syndrome – ODS (range 0-31) |
24.0 (18.0-26.0) |
10.5 (6.0-11.0) |
<0.0001 |
Wexner Scale Constipation scoring system (range 0-30) |
21.0 (17.0-21.0) |
12.0 (7.0-13.0) |
<0.0001 |
Cleveland Clinic Incontinence Score –CCIS (0-20) |
5.0 (3.0-9.0) |
8.0 (3.0-9.0) |
0.4258 |
Pelvic Floor Impact Questionnaire – PFIQ (range 0-300) |
197.4 (156.6-213.9) |
107.1 (80.5-137.2) |
<0.0001 |
Table 2. Functional results of patients with complex PFDs who underwent combined surgical repair by a multidisciplinary team.
|
Before Surgery |
After Surgery |
p |
Medium Anal Resting Pressure |
34.5 (26.0-45.0) |
34 (28.0-45.0) |
0.67 |
Maximum Anal Resting Pressure |
65.0 (49.0-81.0) |
63.5 (55.0-78.0) |
0.55 |
Medium Anal Squeeze Pressure |
34.5 (25.0-53.0) |
41.0 (30.0-51.0) |
0.1 |
Maximum Anal Squeeze Pressure |
89.0 (60.0-120.0) |
90.0 (62.0-130.0) |
0.37 |
Rectal Compliance |
7.6 (4.0-15.0) |
11.2 (5.8-15.0) |
0.03 |
Medium and maximum anal resting pressure are expressed in mmHg, with respectively normal value of > 20 mmHg, and between 50-80 mmHg; Medium and maximum anal squeeze pressure are expressed in mmHg, with respectively normal value of >20 mmHg, and between 100-180 mmHg; Rectal Compliance has normal value of 15-16, expressed in ml/cmH2O
References