A Prospective Observational Study of the Classification of the Perineum and Evaluation of Perineal Repair at the Time of Posterior Colporrhaphy

Christmann-Schmid, Corina; Wierenga, Annemijn P A; Frischknecht, Eveline; Maher, Christopher

doi:10.1097/spv.0000000000000314

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…However, considering the standard deviation, this would label at least half of patients as having deficient perineum. This finding is consistent with previous data . A significant increase in PB was noted postoperatively, with the effect maintained at 8 months.…”

Section: Discussionsupporting

confidence: 93%

Perioperative changes in superficial pelvic organ prolapse quantification system measurements after prolapse surgery

Durnea

Basu

Dadhwal

et al. 2019

Intl J Gynecology & Obste

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Objectives To evaluate the values of perineal body (PB) and genital hiatus (GH) before and after posterior repair. We also evaluated the introital surface area (ISA)—a sum of transverse and longitudinal GH measurements. Methods This secondary analysis of a prospective case series included 94 women undergoing posterior vaginal prolapse surgery at a consultant urogynecology clinic between October 3, 2011, and October 2, 2014. Patients were examined in clinic using the pelvic organ prolapse quantification system with Valsalva maneuver, and in theatre pre‐ and postoperatively with traction. Results Immediately postoperatively, a statistically significant change (all P<0.001) was noted for GH (mean difference −0.59 cm), PB (−0.56 cm), and ISA (−0.87 cm) compared with preoperative measurement. This effect was maintained for GH (−0.42 cm) and PB (−0.40 cm) at 2 months’ follow‐up (both P<0.001), and for PB alone (−0.43 cm; P=0.04) at 8 months. ISA had a moderate correlation with GH (r=0.55). Conclusions Posterior repair significantly improved PB length at months 2 and 8, and GH length at month 2. ISA did not correlate with prolapse stage. Changes in GH were not maintained beyond postoperative month 2.

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Section: Discussionsupporting

confidence: 93%

Perioperative changes in superficial pelvic organ prolapse quantification system measurements after prolapse surgery

Durnea

Basu

Dadhwal

et al. 2019

Intl J Gynecology & Obste

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“…Christmann-Schmid et al published a study of 121 patients undergoing posterior repair where preoperative perineal anatomy was categorized into three groups; normal perineum, short perineum and high/overcompensated perineum. 177 The study included 16 women with a short perineum (pb <2.5 cm) where the authors performed a posterior colporrhaphy plus a perineorrhaphy. The surgical technique included a diamond shaped excision of the perineal skin and mucosa distal to the hymen and surgically merging the detached perineal body structures to the midline.…”

Section: Study IVmentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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“…Deficient perineum: Reduced perineal body measuring less than 2.5 cm and often associated with introital gaping [31] (NEW).…”

Section: Postpartum Perineal and Anorectal Signsmentioning

confidence: 99%

“…Measurement performed at the hymenal ring that describes the distance in centimeters from the midline of the mid-hymenal ring to the commencement of the posterior vaginal skin on the vaginal side of the PR as distinct from the perineal side (perineal body) [ 31 ] (NEW).…”

Section: Signsmentioning

confidence: 99%

An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders

et al. 2022

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Aims The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. Methods This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. Results A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5–10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. Conclusion A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.

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A Prospective Observational Study of the Classification of the Perineum and Evaluation of Perineal Repair at the Time of Posterior Colporrhaphy

Cited by 11 publications

References 16 publications

Perioperative changes in superficial pelvic organ prolapse quantification system measurements after prolapse surgery

Perioperative changes in superficial pelvic organ prolapse quantification system measurements after prolapse surgery

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders

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