Abstract
BackgroundLevator 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.MethodsA 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® and retro-anal ultrasound.ResultsBefore 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).ConclusionAnti-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.
Highlights
Levator plate sagging (LPS), usually called descending perineum syndrome, is one of the main defects encountered in perineology
The first aim of this study is to show the diagnostic importance of "anti-sagging tests" on the symptoms of dyschesia, dysuria, dyspareunia, urinary incontinence, urgency and perineodynia experienced in levator plate sagging while standing
Anti-sagging tests before surgery Besides a clear levator plate sagging, a positive anti-sagging test on a severe perineal symptom is crucial in the indication of a retro-anal levator plate myorrhaphy (RLPM)
Summary
Levator plate sagging (LPS), usually called descending perineum syndrome, is one of the main defects encountered in perineology. This defect is classically associated with coloproctologic functional troubles (dyschesia and anal incontinence) but can induce perineodynia, gynaecological and lower urinary tract symptoms. Perineology is a new speciality that deals with the functional troubles of the three axes of the perineum [1,2,3,4]. The usual name for this levator plate sagging is descending perineum syndrome (DPS) This syndrome is well described by Parks in 1966 [5]. For this author this title is mainly descriptive, as perineal descent on straining is both the cause of symptoms and the most obvious physical sign
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