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Interest of retro-anal levator plate myorrhaphy in selected cases of descending perineum syndrome with positive anti-sagging test.

Beco J - BMC Surg (2008)

Bottom Line: Using retro-anal ultrasound of the levator plate, the mean reduction of sagging was 12.67 degrees (extremes: 1 - 21).Anti-sagging tests can be used before surgery to simulate the effect of RLPM.These results must be confirmed by a larger case series.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Liège, Department of Gynaecology, CHU Notre Dame des Bruyères, Rue de Gaillarmont 600, B-4032 Chênée, Belgium. jacques.beco@skynet.be

ABSTRACT

Background: Levator plate sagging (LPS), usually called descending perineum syndrome, is one of the main defects encountered in perineology. This defect is classically associated with colo-proctologic functional troubles (dyschesia and anal incontinence) but can also induce perineodynia, gynaecological and lower urinary tract symptoms.

Methods: A retrospective case series of nine female patients (mean age: 44.3) underwent an isolated retro-anal levator plate myorrhaphy (RLPM) to treat symptomatic LPS confirmed by rectal examination and/or Perineocaliper. An anti-sagging test (support of the posterior perineum) must significantly improve the symptoms that were resistant to conservative treatment. The effect of the procedure on the symptoms of the 3 axes of the perineum (urological, colo-proctologic and gynecological) and on perineodynia was evaluated during a follow up consultation more than 9 months after surgery. The effect of RLPM on the position of the anal margin and on the levator plate angle was studied using rectal examination, Perineocaliper(R) and retro-anal ultrasound.

Results: Before surgery, anti-sagging tests were positive for dyschesia, urinary urgency and pain. After a mean follow-up of 16.1 months, RLPM resolved or improved 2/2 cases of stress urinary incontinence, 3/5 of urinary urgency, 3/4 of dysuria, 3/3 of anal incontinence, 7/8 of dyschesia, 3/4 of cystocele, 4/5 of rectocele, 5/8 of dyspareunia and 6/7 of perineodynia. Rectal examination showed a complete suppression of sagging in 4 patients and an improvement in the 5 others. The mean reduction of perineal descent was 1.08 cm (extremes: 0-1.5). Using retro-anal ultrasound of the levator plate, the mean reduction of sagging was 12.67 degrees (extremes: 1 - 21).

Conclusion: Anti-sagging tests can be used before surgery to simulate the effect of RLPM. This surgical procedure seems to improve stress urinary incontinence, frequency, nocturia, urgency, dysuria, anal incontinence, dyschesia, dyspareunia, perineodynia, cystocele and rectocele. These results must be confirmed by a larger case series.

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Use of Perineocaliper® (Duchateau SA, Liège, Belgium). A: position of anal margin 2 cm higher than the ischial tuberosities (value = + 2 cm) at rest and in gynecological position (with thighs flexed to 90 degrees). B: during Valsalva's maneuver (red arrow) the anal margin is 1 cm below the ischial tuberosities (value = - 1 cm). View from the top as during clinical measurement. In this case, perineal descent = 3 cm (difference between A and B). 1 = anal margin. 2 = ischial tuberosity. 3 = level of the ischial tuberosities = reference or zero level.
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Figure 1: Use of Perineocaliper® (Duchateau SA, Liège, Belgium). A: position of anal margin 2 cm higher than the ischial tuberosities (value = + 2 cm) at rest and in gynecological position (with thighs flexed to 90 degrees). B: during Valsalva's maneuver (red arrow) the anal margin is 1 cm below the ischial tuberosities (value = - 1 cm). View from the top as during clinical measurement. In this case, perineal descent = 3 cm (difference between A and B). 1 = anal margin. 2 = ischial tuberosity. 3 = level of the ischial tuberosities = reference or zero level.

Mentions: The Perineocaliper® (Duchateau SA, Liège, Belgium) has been developed to evaluate the position of anal margin with respect to the ischial tuberosities at rest and during a Valsalva's maneuver in the gynecological position (with thighs flexed to 90 degrees) (Figure 1).


Interest of retro-anal levator plate myorrhaphy in selected cases of descending perineum syndrome with positive anti-sagging test.

Beco J - BMC Surg (2008)

Use of Perineocaliper® (Duchateau SA, Liège, Belgium). A: position of anal margin 2 cm higher than the ischial tuberosities (value = + 2 cm) at rest and in gynecological position (with thighs flexed to 90 degrees). B: during Valsalva's maneuver (red arrow) the anal margin is 1 cm below the ischial tuberosities (value = - 1 cm). View from the top as during clinical measurement. In this case, perineal descent = 3 cm (difference between A and B). 1 = anal margin. 2 = ischial tuberosity. 3 = level of the ischial tuberosities = reference or zero level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2533292&req=5

Figure 1: Use of Perineocaliper® (Duchateau SA, Liège, Belgium). A: position of anal margin 2 cm higher than the ischial tuberosities (value = + 2 cm) at rest and in gynecological position (with thighs flexed to 90 degrees). B: during Valsalva's maneuver (red arrow) the anal margin is 1 cm below the ischial tuberosities (value = - 1 cm). View from the top as during clinical measurement. In this case, perineal descent = 3 cm (difference between A and B). 1 = anal margin. 2 = ischial tuberosity. 3 = level of the ischial tuberosities = reference or zero level.
Mentions: The Perineocaliper® (Duchateau SA, Liège, Belgium) has been developed to evaluate the position of anal margin with respect to the ischial tuberosities at rest and during a Valsalva's maneuver in the gynecological position (with thighs flexed to 90 degrees) (Figure 1).

Bottom Line: Using retro-anal ultrasound of the levator plate, the mean reduction of sagging was 12.67 degrees (extremes: 1 - 21).Anti-sagging tests can be used before surgery to simulate the effect of RLPM.These results must be confirmed by a larger case series.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Liège, Department of Gynaecology, CHU Notre Dame des Bruyères, Rue de Gaillarmont 600, B-4032 Chênée, Belgium. jacques.beco@skynet.be

ABSTRACT

Background: Levator plate sagging (LPS), usually called descending perineum syndrome, is one of the main defects encountered in perineology. This defect is classically associated with colo-proctologic functional troubles (dyschesia and anal incontinence) but can also induce perineodynia, gynaecological and lower urinary tract symptoms.

Methods: A retrospective case series of nine female patients (mean age: 44.3) underwent an isolated retro-anal levator plate myorrhaphy (RLPM) to treat symptomatic LPS confirmed by rectal examination and/or Perineocaliper. An anti-sagging test (support of the posterior perineum) must significantly improve the symptoms that were resistant to conservative treatment. The effect of the procedure on the symptoms of the 3 axes of the perineum (urological, colo-proctologic and gynecological) and on perineodynia was evaluated during a follow up consultation more than 9 months after surgery. The effect of RLPM on the position of the anal margin and on the levator plate angle was studied using rectal examination, Perineocaliper(R) and retro-anal ultrasound.

Results: Before surgery, anti-sagging tests were positive for dyschesia, urinary urgency and pain. After a mean follow-up of 16.1 months, RLPM resolved or improved 2/2 cases of stress urinary incontinence, 3/5 of urinary urgency, 3/4 of dysuria, 3/3 of anal incontinence, 7/8 of dyschesia, 3/4 of cystocele, 4/5 of rectocele, 5/8 of dyspareunia and 6/7 of perineodynia. Rectal examination showed a complete suppression of sagging in 4 patients and an improvement in the 5 others. The mean reduction of perineal descent was 1.08 cm (extremes: 0-1.5). Using retro-anal ultrasound of the levator plate, the mean reduction of sagging was 12.67 degrees (extremes: 1 - 21).

Conclusion: Anti-sagging tests can be used before surgery to simulate the effect of RLPM. This surgical procedure seems to improve stress urinary incontinence, frequency, nocturia, urgency, dysuria, anal incontinence, dyschesia, dyspareunia, perineodynia, cystocele and rectocele. These results must be confirmed by a larger case series.

Show MeSH
Related in: MedlinePlus