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Posterior Wall Prolapse and Repair

KUDISH, BELA I. MD, MS; IGLESIA, CHERYL B. MD

Clinical Obstetrics & Gynecology: March 2010 - Volume 53 - Issue 1 - pp 59-71
doi: 10.1097/GRF.0b013e3181cd41e3
Vaginal Surgery

Most posterior wall defects occur in combination with other pelvic support disorders. Some patients with rectoceles, the most common posterior wall defect, are asymptomatic, whereas others experience a range of symptoms from a sensation of lower pelvic fullness to defecatory and/or sexual dysfunction. If patients are symptomatic, rectoceles can be treated conservatively with pelvic floor physiotherapy, behavioral therapy, or pessaries. Surgically, the most common rectocele repair is a traditional posterior colporrhaphy which provides excellent cure rates of up to 95%. The studies published to date do not support the use of biologic or synthetic absorbable grafts in reconstructive surgical procedures of the posterior compartment as these repairs have not improved anatomic or functional outcomes over traditional posterior colporrhaphy.

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology,Washington Hospital Center, Washington, DC

Correspondence: Bela I. Kudish, MD, MS, National Center for Advanced Pelvic Surgery, Washington Hospital Center, 106 Irving St. NW., Suite 2100 North, Washington, DC 20010. E-mail: Bela.I.Kudish@medstar.net; belakudish@gmail.com

© 2010 Lippincott Williams & Wilkins, Inc.