Gynaecologists and urologists are commonly faced with the challenge of managing women with posterior compartment prolapse (PCP). A rectocele is fundamentally a defect in the rectovaginal septum, not the rectum, and the size does not correlate with the amount of functional derangement. This problem is associated with diverse symptomatology, including anatomical complaints relating to the bulge and a broad range of functional symptoms including both sexual and defaecatory problems. (1) The difficulties associated with managing this problem have driven women to seek care from a range of surgical specialties. Each specialty, including urologists, gynaecologists and colorectal surgeons, has both strengths and weaknesses in their experience and training in the management of PCP, and they are therefore able to address these problems with varying degrees of success. For many years, the standard operative management of rectocele was a posterior colporrhaphy, which usually included a fascial plication and sometimes a levator plication. Recent surgical developments have led to the introduction of a number of devices to improve success rates of posterior compartment surgery. These include the use of mesh or graft interposition, which may either be a synthetic polypropylene mesh or a biological auto-, allo- or xenograft. Trocar-based kits, including Posterior Prolift, Apogee and Avaulta, have also become extremely popular in the management of PCP. (1)
