Management of patients with rectocele

Abstract

The main objective of this article is to review the management of patients with posterior vaginal wall prolapse. The posterior vaginal wall is inconsistent both in terms of correlating patient symptoms to objective findings and correlating correction of anatomic defects to symptom relief. Therefore, the management of patients with pelvic organ prolapse is challenging and emphasizes the need for surgeons to clearly communicate expectations of surgical repair. Despite these limitations, surgical repair of pelvic organ prolapse in properly selected patients can provide symptomatic relief and improvement in their quality of life and functional status. Review of the literature suggests that traditional posterior colporrhaphy without levatorplasty has superior objective outcomes compared with site-specific posterior repair (grade B), there is a higher dyspareunia rate reported when levatorplasty is employed (grade C), the transvaginal approach is superior to the transanal approach (grade A), there is no benefit of mesh overlay or augmentation of a suture repair (grade B), and while modified abdominal sacrocolpopexy results have been reported, data on how these results would compare with traditional transvaginal repair are lacking. Further studies are needed to optimize the care of patients with posterior vaginal wall prolapse.