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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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Anti-sagging test on a sagittal section. A: sagging of the levator plate – descending perineum syndrome (levator plate or ano-coccygeal raphe in red) during Valsalva's maneuver. B: anti-sagging test: support of the posterior perineum restores normal position. Dotted lines represent structures which are not in the section plane: thin lines = limits of the levator hiatus (increase of its size if perineal descent during Valsalva's maneuver), thick lines = right pudendal nerve (stretching induced by perineal descent). Small red ring = anal sphincter.
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Figure 3: Anti-sagging test on a sagittal section. A: sagging of the levator plate – descending perineum syndrome (levator plate or ano-coccygeal raphe in red) during Valsalva's maneuver. B: anti-sagging test: support of the posterior perineum restores normal position. Dotted lines represent structures which are not in the section plane: thin lines = limits of the levator hiatus (increase of its size if perineal descent during Valsalva's maneuver), thick lines = right pudendal nerve (stretching induced by perineal descent). Small red ring = anal sphincter.

Mentions: The aim of the "anti-sagging tests" is to reduce the sagging of the levator plate, which simulates the effect of retro-anal levator plate myorrhaphy (Figure 3).


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

Beco J - BMC Surg (2008)

Anti-sagging test on a sagittal section. A: sagging of the levator plate – descending perineum syndrome (levator plate or ano-coccygeal raphe in red) during Valsalva's maneuver. B: anti-sagging test: support of the posterior perineum restores normal position. Dotted lines represent structures which are not in the section plane: thin lines = limits of the levator hiatus (increase of its size if perineal descent during Valsalva's maneuver), thick lines = right pudendal nerve (stretching induced by perineal descent). Small red ring = anal sphincter.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Anti-sagging test on a sagittal section. A: sagging of the levator plate – descending perineum syndrome (levator plate or ano-coccygeal raphe in red) during Valsalva's maneuver. B: anti-sagging test: support of the posterior perineum restores normal position. Dotted lines represent structures which are not in the section plane: thin lines = limits of the levator hiatus (increase of its size if perineal descent during Valsalva's maneuver), thick lines = right pudendal nerve (stretching induced by perineal descent). Small red ring = anal sphincter.
Mentions: The aim of the "anti-sagging tests" is to reduce the sagging of the levator plate, which simulates the effect of retro-anal levator plate myorrhaphy (Figure 3).

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