Post-cystectomy enterocele: a case series and review of the literature. To present a case series and literature review on post radical cystectomy (RC) pelvic organ prolapse (POP) to heighten awareness of the symptoms, imaging findings, and risk factors associated with this complication and discuss opportunities for prevention. Women with muscle invasive bladder cancer undergo RC with anterior exenteration, significantly disrupting the pelvic floor. These women are at risk for POP. We present 4 cases of high-grade POP in women who underwent RC for bladder cancer. We reviewed the literature by conducting a Boolean search in PubMed with the terms "("radical cystectomy") AND ("enterocele" OR "pelvic organ prolapse" OR "rectocele" OR "vaginal vault prolapse")." All 4 women reported a bulge sensation
Robot-assisted versus laparoscopic ventral rectopexy for external, internal rectal prolapse and enterocele: a randomised controlled trial. The purpose of this prospective randomized study was to compare robot-assisted and laparoscopic ventral rectopexy procedures for posterior compartment procidentia in terms of restoration of the anatomy using magnetic resonance (MR) defaecography. Sixteen preoperatively and 3 months after surgery. Patient demographics, operation length, operating theatre times and length of in-hospital stay were similar between the groups. The anatomical defects of rectal prolapse, intussusception and rectocele and enterocele were similarly corrected after rectopexy in either technique as confirmed with dynamic MR defaecography. A slight residual intussusception was observed
and/or posterior vaginal wall may also be involved. Uterine prolapse is one of the conditions encompassed by the term pelvic organ prolapse (POP), and the names may be used synonymously. POP describes cystocele (bladder prolapse), rectocele (prolapse of the rectum or large bowel), and enterocele (prolapse of the small bowel); all of these are often associated with prolapse of the uterus. History and examKey
, such as rectocele, enterocele, or intussusception, can be illustrated, as well as the coordination of the pelvic floor musculature during evacuation.[52],[57] A systematic review of 63 studies providing data on outcomes of 7519 barium defecographies and 668 MR defecographies in patients with chronic constipation demonstrated pathological high-grade (Oxford III and IV) intussusception in 23.7% of patients and large (>4 cm) rectoceles in 15.9% of patients. Enterocele descent was observed in 16.8% and perineal descent was observed in 44.4% of patients.[52] Although MRI, performed in the supine position, permits excellent assessment of all pelvic floor compartments and the surrounding musculature,[58] fluoroscopic defecography, performed in the seated position, is considered the evacuation examination
rectopexy (patients with various grades of Oxford Rectal Prolapse Scale, with or without recto- and enterocele), raising concerns over the indirectness of evidence. No comparative evidence was found for the comparators of abdominal rectopexy or intra-anal Delorme’s procedure. A summary of the key features of the studies on comparative safety and effectiveness of minimally invasive ventral rectopexy All patients undergoing surgery for PCPFP Perioperative parameters Safety Functional outcomes Recurrence Yes Population A, LVMR vs RVMR Faucheron et al. (2016) 20 Prospective cohort study 30 days Serious Consecutive patients undergoing day case VMR for total rectal prolapse (75%) or deep enterocele Perioperative parameters Safety Costs Yes Mehmood et al. (2014) 51 Prospective cohort study 12 months
, such as in cases of severe or recurrent prolapse, enteroceles, and defecatory dysfunction, or if patients are not able to tolerate adequate physical examination, or in cases in which findings on clinical evaluation are discordant from patient symptoms. Although patients may have a predominant presenting symptom, pelvic floor abnormalities often involve multiple compartments [3,13]. Global assessment contents at the posterior cul-de-sac may herniate into the rectovaginal space. The cul-de-sac hernia may contain peritoneal fat (peritoneocele), small bowel (enterocele), or sigmoid colon (sigmoidocele). Infolding of the rectal wall into its lumen, rectal intussusception, can be partial thickness (involving only the mucosa) or full-wall thickness and may involve either only the anterior
Recurrence/persistence Complications Important outcomes Psychological outcomes Patient satisfaction Stoma Reoperations for complication Less Important outcomes Hospital stay Withdrawal of intervention/termination Change in radiological features Resolution or reduction in size of rectocele/enterocele/intussusception Duration of the procedure Cost analysis 2.4 Phase 4: literature search The review
and demoralising condition, with negative effects on quality of life. Symptoms include discomfort, pain, constipation, difficult evacuation (obstructed defaecation syndrome), faecal incontinence and discharge of mucus or blood. In women it can be associated with vaginal bulge (rectocele), painful intercourse, lower back pain, urinary dysfunction, and vaginal prolapse and enterocele. Current treatments Current to the sacral promontory with permanent sutures or small metal tacks. The peritoneum is closed over the mesh to prevent the bowel becoming trapped or adhering to the mesh. In women, LVMR may help control rectocele or enterocele associated with rectal prolapse. 3 3 Committee considerations Committee considerations The evidence The evidence 3.1 To inform the committee, NICE did a rapid review of the published
prolapse depending on the organs and sites involved. These include anterior vaginal wall prolapse (including prolapse of the urethra [urethrocele] or bladder [cystocele]) and posterior vaginal wall prolapse (including prolapse of the rectum [rectocele] or small bowel [enterocele]). A woman can present with prolapse of 1 or both of these sites. 2.2 Current treatment options for vaginal wall prolapse
, clinicians should consider the possibility of a more complex disorder involving the pelvic organs [54, 55]. Imaging studies, such as defecography, cystocolpoproctography, or magnetic resonance defecography, can be instrumental in detecting anatomic abnormalities, including rectocele, enterocele, and internal intussusception, as well as concomitant genital prolapse. These studies may also raise suspicion
was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups. Both
reclosed, length of rectum imbricated, length of bowel resected, levatoroplasty, simultaneous vaginal procedure, simultaneous gynecologic procedure, simultaneous enterocele repair, and simultaneous urinary incontinence procedure. Survey represents views of members of the Delphi panel, and may not represent viewpoints of all surgeons. This Delphi survey establishes international consensus descriptors