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Pelvic floor neuropathy in relation to symptoms, anatomy and outcome of vaginal prolapse surgery: a neurophysiologic study
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
(English)Manuscript (Other academic)
Abstract [en]

The aims of this study were to analyze whether neurophysiologic findings of pelvic floor muscles could predict preoperative symptoms of pelvic floor dysfunction and the extent and degree of pelvic organ prolapse and to investigate associations between neurophysiologic findings and the anatomic and subjective outcome of surgery. Forty two women with prolapse stage 2-3 were preoperatively examined with pudendal nerve neurography and concentric needle electromyography of the pubococcygeus and the external anal sphincter muscles. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated median six years postoperatively. The electromyographic findings of the pelvic muscles showed some associations with symptoms of pelvic floor dysfunction but none with degree of prolapse; no discriminatory values were obtained. EMG findings could not predict the outcome of pelvic organ prolapse surgery in terms of changes in symptoms of pelvic floor dysfunction or anatomical outcome.

Keyword [en]
EMG; Genital prolapse surgery, Neuromuscular damage, Outcome, Pelvic floor neuropathy, Pudendal nerve latency
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17415OAI: oai:DiVA.org:liu-17415DiVA: diva2:209035
Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2010-01-14Bibliographically approved
In thesis
1. Genital prolapse surgery: A study of methods, clinical outcome and impact of pelvic floor muscle function
Open this publication in new window or tab >>Genital prolapse surgery: A study of methods, clinical outcome and impact of pelvic floor muscle function
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: To evaluate whether a shift in the extent of genital prolapse surgery occurred between 1983 and 1993. If such a shift occurred, the need for subsequent prolapse surgery; the prevalence of symptoms of pelvic floor dysfunction (PFD) in women six years after vaginal prolapse surgery. And also to analyze predictive factors and the subjective and objective outcomes of prolapse surgery at long term follow up. To evaluate whether neurophysiologic findings of the pelvic floor muscles and anorectal manometry measurements respectively are associated with pre- and postoperative symptoms and the extent of prolapse.

Methods/material: A retrospective study of 542 consecutive patients, operated on for genital prolapse, with primary surgery during 1983 and 1993 in three Swedish hospitals was conducted. Data were obtained from the patient records and were analyzed with emphasis on demographic, clinical and surgical data. A postal questionnaire with validated questions concerning symptoms of PFD was in 1999 sent to women operated in 1993 for primary POP and no subsequent POP surgery.

A prospective study of 42 women with genital prolapse, stage 2-3, scheduled for vaginal prolapse surgery was carried out. Preoperatively the women were examined with anorectal manometry, pudendal nerve neurography and concentric needle electromyography of the pubococcygeus muscles and the external anal sphincter muscle. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated six years postoperatively.

Results: A shift from complete to selective repairs was seen between the two time periods, and posterior repair was often omitted in the latter period. The prevalence of subsequent prolapse surgery increased in the 1990s and the increase was more common in women with a selective repair than in those with complete repair. At long term, PFD-symptoms commonly occurred and were found to be associated with the extent of the prolapse surgery. Symptoms of prolapse and bowel emptying improved significantly after POP surgery in the prospective study. The cure rates of rectocele and apical descent were high, but low concerning cystocele. The results of the neurophysiologic investigations and anal sphincter pressures showed associations with the symptoms and the extent of the prolapse; the individual characteristics showed no discriminatory values.

Conclusion: The extent of the surgical prolapse procedures changed between the two study periods and the extent of subsequent surgery also was greater in the second period. Symptoms of PFD and recurrence of prolapse, especially of the anterior compartment, were frequently seen. Prolapse and bowel symptoms were associated with the function of pelvic floor muscles but neither the results of the neurophysiologic nor the anorectal manometry measurements of the pelvic floor muscles were found to predict anatomical or subjective outcomes of POP surgery. More knowledge is needed of the pathophysiology of PFD in order to develop better means of prevention and to optimize treatment of POP. Development of new methods for identifying all defects of the pelvic floor and surgical techniques for restitution is also warranted for improving outcome of surgical treatment of genital prolapse.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1103
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17417 (URN)978-91-7393-689-7 (ISBN)
Public defence
2009-03-27, Bohmanssonsalen, Universitetssjukhuset, Örebro, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2013-10-10Bibliographically approved

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Crafoord, KristinaBrynhildsen, JanLindehammar, Hans

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