I Just Had Rectal Prolaps Surgery .and Last Night It Prolapsed Again What Do I Do ?

Dis Colon Rectum. Author manuscript; available in PMC 2018 Jul 1.

Published in final edited form equally:

PMCID: PMC5992067

NIHMSID: NIHMS951384

Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse

Tatiana Catanzarite, M.D.,^{1, 2} Daniel D. Klaristenfeld, Yard.D.,³ Marco J. Tomassi, M.D.,³ Gisselle Zazueta-Damian, S.R.A.,ⁱⁱ and Marianna Alperin, M.D., M.Southward.¹

Tatiana Catanzarite

¹Department of Reproductive Medicine, Segmentation of Female person Pelvic Medicine and Reconstructive Surgery, Academy of California, San Diego, San Diego, California

^twoDepartment of Obstetrics and Gynecology, Partition of Urogynecology, Kaiser Permanente, San Diego, California

Daniel D. Klaristenfeld

^threeSection of Full general Surgery, Kaiser Permanente, San Diego, California

Marco J. Tomassi

³Department of Full general Surgery, Kaiser Permanente, San Diego, California

Gisselle Zazueta-Damian

²Department of Obstetrics and Gynecology, Division of Urogynecology, Kaiser Permanente, San Diego, California

Marianna Alperin

¹Department of Reproductive Medicine, Segmentation of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, San Diego, California

Abstract

Groundwork

Pelvic organ prolapse is prevalent among women with rectal prolapse.

OBJECTIVE

This study aimed to make up one's mind whether clinically pregnant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair.

Blueprint

A retrospective cohort.

SETTING

This study was performed at a single managed-care institution.

PATIENTS

Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included.

INTERVENTIONS

There were no interventions.

Master OUTCOME MEASURES

Full-thickness rectal prolapse recurrence was compared betwixt 4 groups: abdominal repair without pelvic organ prolapse (AR−Pop); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR−Popular; and perineal repair with pelvic organ prolapse (PR+Pop). Recurrence-costless period and run a risk of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding chance factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses.

RESULTS

Overall, pelvic organ prolapse was nowadays in 33% of 112 women and was more prevalent amidst subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.viii% at a median of 9 months. The rate of recurrence and the recurrence-costless period differed significantly betwixt groups: AR−POP 3.eight%, 95.7 months; AR+Popular xiii.0%, 86.ix months; PR−Popular 34.viii%, 42.ane months; PR+Pop 57.1%, 23.vii months (p < 0.001). Compared with AR−Pop the HR (95% CI) of rectal prolapse recurrence was three.1 (0.five–18.five) for AR+POP; 14.7 (iii.0–72.9) for PR−Pop and 31.1 (6.ii–154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher chance of recurrence (HR, 10.2; 95% CI, 2.1–49.3).

LIMITATIONS

The retrospective design was a limitation of this study.

CONCLUSIONS

Pelvic organ prolapse was associated with a college rectal prolapse recurrence rate and before recurrence in women undergoing perineal, simply non abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Intestinal repair should be considered in women with concomitant rectal and pelvic organ prolapse. Meet Video Abstract, at http://links.lww.com/DCR/A513.

Keywords: Pelvic floor disorders, Pelvic organ prolapse, Rectal prolapse, Surgical outcomes

Rectal prolapse (RP) is a morbid status that mainly affects women, especially those over 50 years of age.^1–3 Epidemiologic studies demonstrate that pelvic flooring disorders, particularly pelvic organ prolapse (Popular), are mutual amidst women with RP, with reported prevalence betwixt 21% and 34%.^iv,five These rates are essentially higher than the 3% to 6% POP rate in the general female person population over historic period 50,^6,7 making sensation and proper diagnosis of concomitant POP essential for comprehensive treatment of women with RP.^8–14 Published studies abet that women with RP should be managed past a multidisciplinary squad, including colorectal and pelvic reconstructive surgeons.⁵ To appointment, a unifying cause responsible for the pathogenesis of these conditions has not been elucidated, but high prevalence of POP amidst women with RP raises the possibility of a common etiologic pathway.

Rectal prolapse repairs are associated with high failure rates, frequently necessitating reoperations, which increase morbidity and healthcare costs.³ The best surgical approach for treatment of RP remains to be determined, with the virtually contempo Cochrane review unable to establish the superiority of abdominal vs perineal repairs based on existing randomized trials.^xv Despite this, current clinical guidelines recommend intestinal RP repair in advisable patients, because of the increased failure rates of perineal approaches reported in existing studies.³

Although it has been well established that Pop and RP often coexist, to our knowledge, the relationship between POP and RP recurrence (RPR) after surgical repair has not been previously explored. Therefore, the primary objective of this written report was to test the hypothesis that RPR rates are higher in women with clinically significant POP relative to women without Pop. Given the notion that RPR might be greater after perineal vs intestinal repairs, as suggested by existing literature,^two,16–20 we too aimed to appraise the combined effect of Pop and surgical road on outcomes of RP repair.

MATERIALS AND METHODS

This retrospective cohort report of consecutive women who underwent RP repair by 3 board-certified colorectal surgeons at our institution between 2008 and 2016 was canonical by the Southern California Kaiser Permanente Institutional Review Lath. With the use of electronic medical records, subjects were identified by a combination of International Classification of Diseases, Ninth Revision and Tenth Revision codes for RP (569.i, K62.three) and Current Procedural Terminology codes for Delorme (45505), Altemeier (45130), abdominal resection rectopexy (45402), or abdominal nonresection suture or mesh rectopexy (45400). Procedures were verified by the review of medical records. Subjects undergoing emergent procedures were excluded.

The primary outcome of involvement was RPR, defined as full-thickness RP later on initial surgical repair. Subjects with RPR were identified through the review of medical records. The master exposure of involvement was clinically meaning POP, divers every bit at least one of the following: POP symptoms, POP at/beyond the hymen, or history of POP repair. Demographic and clinical characteristics thought to potentially bear upon the charge per unit of RPR were abstracted from medical records (Tabular array i). We assessed the Charlson Co-morbidity Index,²¹ instead of the ASA classification, given the narrow range of ASA classes inside our cohort.

Table 1

Demographic and clinical characteristics of women with and without rectal prolapse recurrence (RPR) post-obit principal surgical repair

Characteristic	No RPR proportion, % (n) n = 91	RPR proportion, % (n) n = 21	p valuea
Age, yb			0.13
20–59	26.four (24)	19.0 (iv)
sixty–79	51.six (47)	38.1 (8)
≥eighty	22.0 (20)	42.ix (9)
Race/ethnicity			0.86
White	79.vi (74)	90.5 (nineteen)
Blackness	one.1 (1)	0
Asian	iv.4 (iv)	4.8 (i)
Hawaiian/Pacific Islander	1.one (one)	0
Hispanic	xi.1 (10)	iv.eight (1)
BMI, kg/10002 c	23.8 ± four.2	23.five ± 4.1	0.79
Parityc	2.2 ± 1.9	2.viii ± 1.6	0.27
Hysterectomy Smoking	47.3 (43)	52.4 (11)	0.81
Current	4.iv (5)	23.8 (five)
Former	34.1 (31)	28.6 (six)
Never	61.v (56)	47.half dozen (10)
Connective tissue disorder/myopathy	eight.eight (8)	4.8 (1)	1
Charlson Comorbidity Alphabetizec	one.1 ± i.5	1.6 ± 1.8	0.16
Constipation	37.4 (34)	33.iii (7)	0.73
Fecal incontinence	51.6 (47)	66.vii (14)	0.21
Pelvic organ prolapse (POP)	28.6 (26)	52.four (11)	0.04
Blazon of surgery			<0.001
Intestinal resection rectopexy	45.1 (41)	9.5 (two)
Abdominal nonresection rectopexy	31.9 (29)	fourteen.3 (3)
Perineal Delorme repair	12.i (xi)	42.9 (9)
Perineal Altemeier repair	11 (10)	33.3 (7)
Popular/blazon of surgery			<0.001
Abdominal repair/no POP	96.2 (50)	3.eight (2)
Abdominal repair + Pop	87.0 (20)	13.0 (3)
Perineal repair/no Popular	65.2 (xv)	34.8 (eight)
Perineal repair + POP	42.9 (6)	57.1 (viii)

To decide the combined effect of Pop and repair route on RPR, subjects were categorized into groups based on Pop and the type of surgical approach (Pop/surgery blazon). Abdominal repairs (ARs) included resection and nonresection rectopexies, and perineal repairs (PRs) included Delorme and Altemeier procedures. The post-obit iv groups were compared: i) AR without POP (AR−POP); 2) AR with Pop (AR+POP); 3) PR without POP (PR−POP); and four) PR with POP (PR+POP). Univariable analysis of potential confounders for RPR was conducted using χ² and Pupil t tests for categorical and continuous variables. Significant variables (α < 0.ane) were included in stepwise backward binomial logistic regression analysis to identify contained association with RPR. Age and connective tissue disorder (CTD)/myopathy were included in the regression analysis a priori, considering of the high biological plausibility of their effect on both the event and the exposure of interest.^4,22–24 Given the heterogeneity of the POP group and potential that women undergoing combined Pop and RP repairs may comport differently with respect to recurrence, sensitivity assay was performed after excluding women undergoing combined repairs. Comparisons were repeated with the statistical tests noted to a higher place. Given differences in follow-up time, recurrence-free period (months) and the adventure of RPR were compared between groups by using Kaplan-Meier and Cox proportional hazards methods. The Breslow test was chosen for statistical estimation of survival analyses, because log-rank exam assumptions were not satisfied. Results for univariable comparisons are presented equally mean ± SD, and those for survival analyses are presented in mean ± SEM. All analyses were performed using Statistical Package for the Social Sciences (SPSS, Chicago, IL), version 24.

RESULTS

Among the 112 women who constituted the report cohort, 67% underwent RP repair via the intestinal route (75/112), including 43 of 75 (57.3%) resection rectopexies and 32 of 75 (42.7%) nonresection rectopexies. The majority of ARs were performed using minimally invasive conventional laparoscopic or robotic-assisted approaches, including thirty of 32 (93.8%) nonresection and 35 of 43 (81.4%) resection rectopexies. Perineal repairs were performed in 33% (37/112), including twenty of 37 (54.1%) Delorme and 17 of 37 (45.ix%) Altemeier procedures. Median time to expiry or terminal follow-up was 42.5 months (range, one–100). Eleven subjects (nine.8%) died during the follow-up period. The overall complication rate was 31.viii%, with an average Clavien-Dindo score of 1.94. The rate of pocket-sized complications was 11.8%, and the rate of major complications, defined as Clavien-Dindo classification ≥2, was twenty%. Comparisons betwixt ARs and PRs did non reveal a significant difference in the rate of overall complications (AR 35.6% vs PR 24.3%, p = 0.3), pocket-size complications (AR 15.1% vs PR v.iv%, p = 0.2), or major complications (AR 20.5% vs PR 18.9%, p = 0.8).

The overall charge per unit of RPR, diagnosed at a median of 9 months (one–79), was 18.8% (21/112). Women with and without RPR did not differ with respect to most demographic and clinical characteristics examined (Table one). All the same, subjects with RPR were more probable to have undergone PR (76.2% vs 23.8%, p < 0.001) and to smoke at the time of RP surgery (23.8% vs 4.4%, p = 0.01). The rate of RPR subsequently intestinal resection rectopexies (4.7%) was similar to nonresection (9.iv%) rectopexies (p = 0.half dozen), likewise every bit after Delorme (45.0%) compared with Altemeier (41.ii%) procedures (p = 0.8).

Xxx-three percent (37/112) of women met criteria for Pop. In the vast majority (33/37, 89.2%), POP was diagnosed based on objective Pelvic Organ Prolapse Quantification (Popular-Q) exam. Amidst subjects for whom Popular-Q examination was bachelor, inductive and posterior compartments constituted the leading edge of Popular in 15 of 33 (45.5%) and xi of 33 (33.3%). The remaining vii of 33 (17.7%) subjects with Pop had predominantly apical prolapse. All women with subjective POP symptoms were among these 33 subjects. In the remaining iv of 37 (10.8%) women, POP was diagnosed based on history of Popular surgery before RP repair, with 2 subjects having undergone posterior colporrhaphy: 1, anterior colporrhaphy; and 1, vaginal hysterectomy for apical prolapse.

There was a significantly higher rate of POP among subjects who developed RPR (52.4%) than among those who did not (28.vi%), p = 0.04. Importantly, women with and without POP did non differ with respect to either the surgical approach for RP repair (p = 0.4) or smoking status (p = 0.3). The rates of RPR, which increased with both concomitant Popular and perineal road of surgery, were as follows: iii.8% for AR−Popular, thirteen.0% for AR+POP, 34.8% for PR−POP, and 57.i% for PR+Popular. Four subjects underwent concomitant POP repairs, performed by board-certified Female Pelvic Medicine and Reconstructive Surgery specialists at the time of RP repair. Two underwent sacrocolpopexy concomitantly with nonresection rectopexy, 1 underwent extraperitoneal colpopexy and posterior colporrhaphy at the fourth dimension of a Delorme procedure, and one underwent posterior colporrhaphy concomitantly with resection rectopexy. None of these 4 patients experienced RPR.

The just cistron independently associated with RPR on multivariable regression analysis was Pop/surgery blazon (Tabular array 2). It is notable that Pop did non confer a college risk of RPR in women who had AR (OR, 4.eight; 95% CI, 0.6–42.7 for AR+Popular vs AR−Pop). Fifty-fifty though PR was associated with a higher RPR rate for all women, the risk of RPR was farther dramatically increased in women with Popular who underwent PR, relative to women without Popular. Compared with the AR−Pop group, designated every bit a reference group, the OR for RPR was 136.5 (95% CI, 8.ane–2295.3) in PR+Pop, essentially exceeding that of PR−POP group (OR, 55.ix; 95% CI, 3.3–940.1). Afterward backward stepwise emptying, the only variable remaining in the final model was Pop/surgery blazon. In the concluding model, using AR−Pop as the reference grouping, the ORs for RPR for each group were as follows: AR+Popular 3.8 (95% CI, 0.half dozen–24.two), PR−Popular 13.3 (95% CI, 2.6–69.7), and PR+POP 33.3 (95% CI, 5.7–194.9).

Table ii

Categorized dependent binomial assay with RPR as master outcome

Characteristic	No RPR proportion, % (n) n = 91	RPR proportion, % (n) n = 21	OR	95% CI
POP and surgical road
AR−POP	96.two (l)	three.viii (2)	Ref	Ref
AR+Popular	87.0 (xx)	13.0 (iii)	4.8	0.6–42.7
PR−POP	65.2 (15)	34.8 (8)	55.9	3.3–940.i
PR+Popular	42.9 (half-dozen)	57.1 (eight)	136.5	viii.ane–2295.three
Smoking
Never smoker	4.4 (five)	23.8 (v)	Ref	Ref
Current smoker	34.1 (31)	28.half-dozen (6)	five.iii	0.8–33.ii
Quondam smoker	61.5 (56)	47.6 (ten)	1	0.three–3.7
Age, ya
20–59	26.four (24)	19.0 (four)	Ref	Ref
60–79	51.6 (47)	38.1 (8)	0.12	0.01–1.four
≥eighty	22.0 (20)	42.nine (ix)	0.14	0.01–2.ane
Connective tissue disorder/myopathy	8.8 (8)	iv.eight (1)	1.7	0.1–22.1

Sensitivity analysis was performed excluding subjects (n = four) who underwent concomitant POP and RP repair. The human relationship between POP and RPR persisted (13.iii% for no POP vs 33.3% for POP, p = 0.02). Results were also similar on multivariable regression analysis, in which, compared with AR−POP, AR+Pop conferred OR ii.7 (95% CI, 0.4–19.0), PR−POP OR 12.iv (95% CI, 2.iii–68.1), and PR+POP OR 38.four (95% CI, 6.0–245.3). Interestingly, in this assay, current smoking conferred an independent risk of RPR (OR, vii.ix; 95% CI, 1.3–48.5).

Average fourth dimension to recurrence differed significantly between groups, with the longest recurrence-free period in AR−Pop (95.vii ± 3.0 months), compared with AR+Popular (86.9 ± half dozen.vii months), PR−POP (42.1 ± 7.1 months), and PR+Pop (23.7 ± 6.3 mo.), p < 0.001 (Fig. 1). Interestingly, pairwise comparisons revealed a similar time to recurrence between AR–POP and AR+Popular (95.7 vs 86.9 months, p = 0.5), but nearly double the length of recurrence-free catamenia in PR−POP, compared with PR+Pop (42.1 vs 23.7 months, p < 0.018). Amongst subjects with Popular, the recurrence-free period was 4 times longer in AR+Pop, compared with the PR+POP grouping (86.9 vs 23.7 months, p < 0.001). Relative to AR−POP, Cox proportional hazards ratios (Hour (95% CI)) for RPR were as follows: AR+POP: 3.1 (0.v–eighteen.v), PR−POP: 14.7 (iii.0–72.9) and PR+POP: 31.ane (6.2–154.5). Hazard of recurrence was also higher for PR+POP relative to AR+POP (60 minutes, 10.2; 95% CI, 2.1–49.3).

Comparing of recurrence-free menstruation, in months, after surgical rectal prolapse repair betwixt the following groups: 1) intestinal repair without pelvic organ prolapse (AR−Pop); 2) abdominal repair with pelvic organ prolapse (AR+Pop); three) perineal repair without pelvic organ prolapse (PR−POP), and 4) perineal repair with pelvic organ prolapse (PR+POP).

DISCUSSION

To our knowledge, this is the first study to demonstrate a relationship between clinically significant Pop and recurrence afterward master RP repair. In our cohort of 112 female subjects, the prevalence of clinically significant POP was 33%, consistent with reported POP rates in women with RP,^iii–5 and substantially greater than the 3% to 6% rate in the age-comparable full general female population.^six,7 Among subjects who underwent perineal RP repair, the rate of RPR was significantly college in women with Pop (57.ane%), compared with women without POP (34.8%). In subjects without POP, hazard of RPR was significantly higher later on perineal RP repair (HR, 14.7), compared with the outcomes observed in the abdominal rectopexy group. Importantly, the risk of RPR after PR was further dramatically increased in women with Popular (HR, 31.one). In contrast, the presence of POP did not significantly alter the risk of RPR after AR (Table 2). Both Popular and perineal surgical routes were associated with earlier recurrence of RP, with the shortest recurrence-gratuitous period in subjects with POP undergoing PR (Fig. 1).

It is important to note that, despite the overall high charge per unit of POP in this cohort, Popular was essentially more prevalent in subjects with RPR relative to women who had successful RP repair. These results support our hypothesis that POP is not simply associated with primary RP, but information technology also serves as a risk factor for RPR after surgical repair. Some other important finding of our study is that the coexistence of POP and RP is associated with substantially higher recurrence rates and before time to RPR in women undergoing primary PR of RP. In contrast, abdominal approaches for RP repair appear to mitigate this chance, with comparable patterns of RPR in women with and without concomitant Popular. Interestingly, the significantly college failure rate of perineal simply not intestinal RP repairs in women with POP, identified in this study, resonate with the information in the field of female pelvic medicine. Published studies comparing outcomes of various surgical modalities for POP correction favor intestinal sacrocolpopexies over vaginal native tissue repairs. The most recent Cochrane review on this topic reports a 41% rate of POP recurrence later vaginal repairs, compared with 23% afterward abdominal sacrocolpopexy, as well equally higher rates of reoperation for prolapse (RR, ii.3) and recurrent bothersome prolapse symptoms (RR, 2.1) after vaginal procedures. Information technology would, therefore, prove fruitful to explore possible common etiologic pathways that business relationship for the increased success of abdominal surgical approaches for POP and RP repair in the future. Our findings provide a compelling statement for surgeons to strongly consider ARs in women with concomitant POP and RP. To take Popular into account during preoperative planning and to facilitate individualized counseling, it is essential that female person patients with RP exist assessed for the presence of POP. Integrated care of women with rectal prolapse by female pelvic medicine and colorectal surgery specialists would enable standardized assessment of pelvic organ support via a validated POP-Q examination.^25,26 In line with previously proposed recommendations,^3,five our report provides further show in support of multidisciplinary management of women with RP and routine screening for POP.

Information technology has been previously suggested that connective tissue aberrations constitute a common etiologic pathway underlying both RP and POP.^4,24 This notion is strengthened by the observations of higher rates of RP and POP amid women with hereditary CTDs, such as Marfan and Ehlers-Danlos syndrome,^23,27 and alterations in elastin composition and metabolism.^28,29 Although CTD/myopathy was not significantly associated with RPR in our study, likely because of the small numbers, it is possible that some women had undiagnosed or subclinical connective tissue abnormalities that predisposed them to RP, Popular, and RPR. Consistent with previously published findings,²² nosotros did not identify aging as an independent hazard factor for RPR. We too explored whether smoking is a risk gene for RP repair failure, given a well-known detrimental impact of smoking on tissue regeneration.^xxx Smoking, still, was not an independent risk factor for RPR in our overall accomplice, although an contained association was found after excluding those patients undergoing concomitant POP and RP repair.

Strengths of our study include the uniform operative technique by iii surgeons at a single establishment and a stable managed-care population, enabling long-term follow-up. Limitations of this study are inherent to its retrospective design and the small number of subjects in some of the groups. Consistent with do patterns beyond other institutions in the U.s., our patients are not scheduled for routine surveillance examinations by colorectal surgeons afterwards RP repair outside the firsthand postoperative period, which could potentially consequence in the underestimation of RPR. Withal, the rate of RPR identified in the current study is consistent with the published literature. Furthermore, to address the above, we capitalized on the advantages offered past our closed managed-intendance organization. Nosotros used time to last meet every bit a surrogate for fourth dimension to last follow-up, based on the assumption that patients with RPR who keep to receive primary and other specialty care inside our system would present to our group for reevaluation. Future studies with standardized follow-upwards intervals will exist useful. Also, not all women included in the cohort had undergone a standardized POP-Q exam. Fifty-fifty though routine screening for Popular has non been instituted at the time of this study, Popular at/ distal to the hymen, a well-established metric of clinically relevant Popular and surgical failure, would be apparent during the examination of RP conducted in all subjects. Importantly, POP at/distal to the hymen strongly correlates with POP symptoms. Thus, we defined clinically meaning Popular as history of Pop surgery, subjective written report of vaginal burl, and Pop at or across the hymen, because these are well-established metrics of clinically relevant Pop and surgical failure of POP repairs.^31–33 Importantly, the majority of women categorized as having Popular in our accomplice (33/37, 89.2%) had undergone Popular-Q exam, with the remaining subjects categorized as having Popular based on a history of POP surgery. We conducted sensitivity analysis after excluding women who underwent combined RP and POP procedures to confirm that the inclusion of these women was not skewing our results; the meaning positive association betwixt RP and POP persisted on both univariate and logistic regression analysis.

Given that only 4 subjects in our accomplice underwent concomitant RP and Popular repairs, the numbers were as well small for meaningful analysis to be conducted in this subgroup. To engagement, there are no published randomized control trials evaluating the role of Popular correction on the outcomes of RP repairs. A contempo retrospective written report of 59 women who underwent ventral rectopexy with concurrent sacrocolpopexy or hysteropexy demonstrated a 57.4% composite success rate, defined as the absence of subjective and objective recurrent pelvic organ or RP at a median follow-upwardly of 17 months.³⁴ Prospective trials investigating the bear upon of concomitant RP and Popular repairs on surgical outcomes are an important expanse for hereafter research. Despite these limitations, our study contributes important novel information regarding the impact of POP on recurrence patterns later on surgically treated primary RP.

Determination

The overall rate of RPR is higher in women with pelvic organ prolapse than in those without. Perineal RP repairs are associated with essentially higher adventure of RPR and shorter time to recurrence in women with both rectal and pelvic organ prolapse, compared with women who practice not accept pelvic organ prolapse. Intestinal approaches for handling of RP appear to mitigate the additional risk of procedure failure in women with pelvic organ prolapse. Surgeons should strongly consider abdominal RP repair in women with concomitant rectal and pelvic organ prolapse. We recommend that women with RP undergo a multidisciplinary evaluation and routine screening for pelvic organ prolapse to facilitate individualized preoperative counseling. Time to come prospective studies are needed to further evaluate the impact of pelvic organ prolapse on RPR patterns post-obit surgical repair and to evaluate potential common etiologic pathways accountable for these morbid weather condition.

Acknowledgments

Funding/Support: National Found of Aging Grant #R03AG050951

Footnotes

Fiscal Disclosures: None reported.

Poster presentation at the meeting of the American Urogynecologic Society, Denver, CO, September 27 to October 2, 2016.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992067/

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