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. 2021 Aug;32(8):2233-2237.
doi: 10.1007/s00192-020-04476-1. Epub 2020 Nov 16.

Does the presence of a true radiological rectocele increase the likelihood of symptoms of prolapse?

H P Dietz  1 , B Brown  2 , T Friedman  3 , N Subramaniam  2
Affiliations

Does the presence of a true radiological rectocele increase the likelihood of symptoms of prolapse?

H P Dietz et al. Int Urogynecol J. 2021 Aug.

Abstract

Introduction and hypothesis: Posterior compartment prolapse is commonly due to a 'true' rectocele, i.e., a diverticulum of the rectal ampulla. This condition is associated with symptoms of obstructed defecation and may contribute to prolapse symptoms. We tested the hypothesis: 'A true rectocele is an independent predictor of symptoms of prolapse.'

Methods: This was a retrospective cohort study of patients presenting to a urogynecology unit for symptoms of pelvic floor dysfunction between September 2011 and June 2016. Assessment included a structured interview, POP-Q examination and 4D TLUS. Ultrasound volume data were acquired on Valsalva. Offline measurements were performed by analysis of stored volume data sets at a later date, blinded to all clinical data.

Results: One hundred six patients were excluded because of incomplete data. Of the remainder, Bp was the most distal point on POP-Q in 348. Statistical analysis was performed on this cohort. Mean age was 60 (33-86) years and mean BMI 31 (18-55) kg/m². One hundred fifty-three patients (44%) presented with symptoms of prolapse; 272 were diagnosed with a true rectocele on TLUS. Bp on POP-Q and true rectocele on TLUS were both significantly associated with prolapse symptoms; however, on multivariate analysis the latter became nonsignificant (p = 0.059). Receiver-operating characteristic (ROC) analysis confirmed that the presence of a true rectocele on TLUS did not contribute significantly to symptoms of prolapse (AUC 0.66 for model with rectocele, AUC 0.65 without).

Conclusions: The presence of a true rectocele on TLUS does not seem to contribute substantially to the manifestation of clinical symptoms of prolapse.

Keywords: Pelvic organ prolapse; Rectocele; Translabial ultrasound.

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