Introduction and hypothesis Descending Perineum Syndrome (DPS) is a coloproctologic disease and the best treatment for it is yet to be defined. DPS is frequently associated with pelvic organ prolapse (POP) and it is reasonable to postulate, that treatment of POP will also have an impact on DPS. We aimed to evaluate the subjective satisfaction and improvement of DPS for patients who have undergone a sacral colpoperineopexy associated with retrorectal mesh for concomitant POP. Methods: This retrospective cohort study, conducted between February 2010 and May 2016 included all women who have undergone surgery to treat POP and DPS. Improvement of POP was assessed clinically and subjective satisfaction was assessed with a questionnaire. Results: Among the 37 operated patients, 31 responded to the questionnaire and 77,4% were satisfied with this surgical procedure. 94,6% were objectively cured for POP. There was a 60% improvement rate for constipation, 63,5% and 68% were cured or improved for ODS and the need for digital maneuvers respectively. Conclusion: Sacralcolpoperineopexy associated with retro rectal dorsal mesh appears to objectively and subjectively improves pelvic organ prolapse associated with DPS.

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Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results.

Colpocystodefecography (CCD) and dynamic MRI with defecography (MRId) permit an alternation between filling and emptying the hollow organs and the maximum abdominal strain offered by the defecation. The application in imaging of these two principles reveal the masked or underestimated prolapses at the time of the physical examination. Rigorous application of the technique guarantees almost equivalent results from the two examinations. The CCD provides voiding views and improved analysis of the anorectal pathology (intussusceptions, anismus) but involves radiation and a more invasive examination. MRId has the advantage of providing continuous visibility of the peritoneal compartment, and a multiplanar representation, enabling an examination of the morphology of the pelvic organs and of the supporting structures, but with the disadvantage of still necessitating a supine examination, resulting sometimes in an incomplete evacuation. The normal and abnormal results (cystoptosis, vaginal vault prolapse, enterocele, anorectal intussuception, rectocele, descending perineum, urinary and fecal incontinence) and the respective advantages and the limits of the various imaging methods are detailed. Morphological and dynamic imaging are essential complementary tools to the physical examination, especially when a precise anatomic assessment is required to understand the functional complaint or when a reintervention is needed.

Rôle de l’imagerie dans l’exploration des troubles de la statique pelvienne

Statique pelvipérinéale postérieure de la femme et ses troubles : données anatomiques et cliniques

Resume L’article traite des problemes particuliers lies a la prise en charge des prolapsus genitaux chez les patientes ayant une neuro-vessie. Parce que la litterature sur le sujet est particulierement pauvre, il nous a semble important de souligner les risques evolutifs dans ce cadre particulier.

Chapitre E - Particularités du prolapsus génital de la blessée médullaire

RESUME Les troubles de la statique pelvienne interessent les trois etages du plancher pelvien et necessitent une prise en charge globale. Ils sont souvent associes car leur physiopathologie obeit au meme determinisme a savoir un desequilibre entre les forces de poussee et les forces de retenue representees par le systeme d’amarrage des visceres pelviens et le plancher pelvien forme par le fascia endopelvien et les muscles du perinee dont l’elevateur de l’anus. L’exploration clinique comprend un examen qui doit etre fonctionnel et anatomique permettant d’analyser les trois etages pour rechercher les troubles patents et masques. Lorsque l’examen clinique ne suffit pas il faut s’aider d’examens d’imagerie parmi lesquels on distingue le colpocystogramme qui est realise debout sur un perinee « verrouille » et la defecographie qui est realisee en position d’exoneration sur un perinee « relaxe » ainsi que l’imagerie par resonance magnetique nucleaire. Le traitement doit prendre en compte les dysfonctionnements, les incontinences, et les ptoses des trois etages. Les differents examens et les techniques de traitement par voie abdominale ou vaginale sont discutes en fonction des donnees et de l’experience de l’auteur. Dans tous les cas le choix therapeutique repose sur l’âge de la patiente, les degradations anatomiques, les troubles fonctionnels et l’aptitude du chirurgien.

Réflexions sur la prise en charge des troubles de la statique pelvienne

Le syndrome du perinee descendant decrit en 1970 par PARKS reste d'interpretation physiopathologique et clinique difficile. A partir de la litterature, de 1966 a 2004, et de la lecture retrospective de 1023 colpocystogrammes, une revue generale sur le perinee descendant a ete effectuee. La symptomatologie observee est le plus souvent secondaire a des lesions associees. Les perinees descendants radiologiques n'ont pas toujours de traduction clinique. Le colpocystogramme montre la descente perineale et les troubles associes de la statique pelvienne anterieurs et moyens alors que la defecographie permet de mieux expliquer la dyschesie qui resulte en general d'un trouble posterieur associe (rectocele avec intussusception rectale). La prise en charge des perinees descendants repose sur le traitement medical et la reeducation. Il n'y a pas de consensus concernant le traitement chirurgical. La chirurgie traite en general les lesions associees. En cas d'effondrement complet du perinee, la voie abdominale avec soutien sous vesical, pre et retro-rectal, fixe sans tension au promontoire, pourrait etre interessante alors qu'une refection transanale du rectum a l'agrafeuse pourrait etre proposee lorsque le perinee descendant n'est associe qu'a une intussusception rectale ou a une rectocele.

Descending perineum in women

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Descending perineum in women