Urinary Consequences and Pelvic Floor Stability in Women Undergoing Stapled Hemorrhoidopexy for Prolapse: Is This Still the Right Procedure?

F A Morfesis, MD FACS, Brian P Rose, BS, Francesca N Morfesis, MA. Owen Drive Surgical Clinic of Fayetteville, East Carolina University, Duke University Medical Center

Introduction: The use of stapled hemorrhoidopexy or PPH for the treatment of Class III and IV internal hemorrhoids has become standard since its induction. Patients often show superior return to normal activities and are pain free more quickly than the traditional, more invasive open approach. This study aimed to identify pelvic floor stability in women who present with prolapse and elect to undergo stapled hemmorhoidopexy in hopes to assess the validity of this procedure in select population.

Methods: Women were selected to undergo stapling based upon prolapse presentation. A validated urologic score endorsed by the American College of Urology was used. Women were assessed both pre-operatively and at 1 month post-surgery.

Results: Initial scores in urinary function ranged 0-18 with a maximum score of 20 pre-operatively. This same group reported a 1 month post-operative score ranging from 1 to 15. Patients who reported pre-op difficulty with frequency, sudden urges to urinate, and sleeplessness reported increases in such difficulties post-op. Decreases were seen in spillage of urine during daily routines.

Conclusions: This limited case series explores the implications of stapled hemorrhoidopexy in women ages 32-61 for prolapse. The stapling approach is regarded as less invasive compared to traditional open hemorrhoidectomy, but with some remaining consequences in perviously described anal tone and urinary continence. This ultimately begs the question whether or not such procedures should be used in select populations or more attention should be placed into investigating the long term consequences of other treatment modalities.

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