MODERN APPROACHES TO THE TREATMENT OF GENITAL PROLAPSE IN WOMEN WITH EXTRAGENITAL PATHOLOGY
DOI:
https://doi.org/10.11603/24116-4944.2022.1.13248Keywords:
genital prolapse in women, surgical treatment, chronic diseases of the respiratory system, adiposity, diabetesAbstract
The aim of the study – to increase the effectiveness of treatment and prevent recurrences of genital prolapse in women with chronic extragenital diseases.
Materials and Methods. 139 women with genital prolapse were examined. Among them 70 had genital prolapse combined with extragenital pathology (main group), and 69 had genital prolapse (comparison group). 20 patients with genital prolapse of the main group, who suffered from chronic diseases of the respiratory system, made up 1 subgroup; 20 women with genital prolapse who were obese were included in 2 subgroups, and 30 women suffering from type 2 diabetes were included in 3 subgroups. The types of surgical intervention depended on the patients' extragenital pathology.
Results and Discussion. Analyzing the amount of surgical intervention by group, it was determined that transvaginal extirpation of the uterus without appendages, anterior colporrhaphy, colpoperineoraphia with levatoroplasty, sacrospinal colpopexy was performed mainly with incomplete prolapse of the genitals. Anterior colporrhaphy, colpoperineorrhaphy with levatoroplasty, sacrospinal colpopexy with a mesh endoprosthesis were performed mainly in the case of complete or incomplete genital prolapse with the presence of accompanying extragenital pathology. Unilateral sacropexy allows you to reduce the time of surgery due to unilateral, not bilateral fixation, which does not reduce the effectiveness of surgical intervention. The use of a polypropylene mesh prosthesis gives almost the same number of recurrences in women of the main group and the comparison group.
Conclusions. A personalized approach in the treatment of genital prolapse in women with chronic extragenital pathology contributes to increasing the effectiveness of surgical measures and reducing the recurrence of the disease. The use of a polypropylene mesh endoprosthesis helps to prevent relapses, increases efficiency and can be recommended for use in gynecological practice. The performance of unilateral sacrospinal colpopexy in elderly women followed by the use of suppositories with hyaluronic acid in the early postoperative period also demonstrates an increase in the effectiveness of surgical treatment of genital prolapse and contributes to the reduction of disease recurrence.
References
Fleischer, K, & Thiagamoorthy, G. (2020). Pelvic organ prolapse management. Post Reprod Health, 26 (2), 79-85. DOI: 10.1177/2053369120937594.
Weintraub, A.Y., Glinter, H., & Marcus-Braun, N. (2020). Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int. Braz. J. Urol., 46 (1), 5-14. DOI: 10.1590/S1677-5538.IBJU.2018.0581.
Pujol-Gualdo, N., Läll, K., Lepamets, M. & Estonian Biobank Research Team, & Rossi, H.R., & Arffman, R.K., et al (2022). Advancing our understanding of genetic risk factors and potential personalized strategies for pelvic organ prolapse. Nat Commun, 23,13 (1), 3584. DOI: 10.1038/s41467-022-31188-5..
Gillor, M., Saens, P., & Dietz, H.P. (2021). Demographic risk factors for pelvic organ prolapse: Do smoking, asthma, heavy lifting or family history matter? Eur. J. Obstet. Gynecol. Reprod. Biol., 261, 25-28. DOI: 10.1016/j.ejogrb.2021.04.006
Leng, B., Zhou, Y., Du, S., Liu, F., &Zhao, L., Sun, G., & Zhao, Y. (2019). Association between delivery mode and pelvic organ prolapse: A meta-analysis of observational studies. Eur. J. Obstet. Gynecol. Reprod. Biol., 235, 19-25. DOI: 10.1016/j.ejogrb.2019.01.031
Lee, U.J., Kerkhof, M.H., van Leijsen, S.A., & Heesakkers, J.P. (2017). Obesity and pelvic organ prolapse. Curr. Opin. Urol., 27 (5), 428-434. DOI: 10.1097/MOU.0000000000000428.
Baessler, K., Christmann-Schmid, C., &Maher, C., Haya, N., Crawford, T.J., & Brown, J. (2018). Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst. Rev., 19, 8 (8). DOI: 10.1002/14651858.CD013108
Davidson, E.R.W., Thomas, T.N., Lampert, E.J., Paraiso, M.F.R., & Ferrando, C.A. (2019). Route of hysterectomy during minimally invasive sacrocolpopexy does not affect postoperative outcomes. Int. Urogynecol. J., 30 (4), 649-655. DOI: 10.1007/s00192-018-3790-4.
Abdool, Z., Dietz, H.P., & Lindeque, B.G. (2017). Prolapse symptoms are associated with abnormal functional anatomy of the pelvic floor. Int. Urogynecol. J., 28 (9), 1387-1391. DOI: 10.1007/s00192-017-3280-0
American Diabetes Association (2018). Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care, 41, 13-27. DOI: 10.2337/dc18-S002
Isık, H., Aynıoglu, O., Sahbaz, A., Selimoglu, R., Timur, H., & Harma, M. (2016). Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? Eur. J. Obstet. Gynecol. Reprod. Biol., 197, 59-62. DOI: 10.1016/j.ejogrb.2015.11.035.
Dieter, A.A. (2021). Pelvic organ prolapse: Controversies in surgical treatment. Obstet. Gynecol. Clin. North Am., 48 (3), 437-448. DOI: 10.1016/j.ogc.2021.05.001
Abdool, Z., Dietz, H.P., & Lindeque, B.G. (2017). Prolapse symptoms are associated with abnormal functional anatomy of the pelvic floor. Int. Urogynecol. J.,28 (9), 1387-1391. DOI: 10.1007/s00192-017-3280-0.
Safonov, R.A., Lazurenko, V.V., Cherniak, O.L., Liashchenko, O.A., & Ovcharenko, O.B. (2020). Profilaktyka retsydyvu henitalnoho prolapsu u zhinok pokhyloho viku pislia khirurhichnoho vtruchannia [Prevention of recurrence of genital prolapse in elderly women after surgery]. Reproduktyvna endokrynolohiia – Reproductive Endocrinology, 4 (54), 95-98. DOI: 10.18370/2309-4117.2020.54.95-98 [in Ukranian].
Nakai, K., Hamuro, A., Kitada, K., Tahara, M., Misugi, T., & Nakano, A., et al (2021). Preliminary evaluation of the short-term outcomes of polytetrafluoroethylene mesh for pelvic organ prolapse. J. Obstet. Gynaecol. Res., 47 (7), 2529-2536. DOI: 10.1111/jog.14795
Tsiapakidou, S., Campani Nygaard, C., Pape, J., de Mattos Lourenço, T.R., & Falconi, G., & Betschart, C. et al. (2021). CHORUS: An International Collaboration for Harmonising Outcomes, Research, and Standards in Urogynaecology and Women's Health. Evaluation of guidelines on the use of vaginal mesh implants for pelvic organ prolapse using the AGREE II instrument. Int. J. Gynaecol. Obstet., 154 (3), 400-411. DOI: 10.1002/ijgo.13622
Hamuro, A., Tachibana, D., Wang, H., Hayashi, M., Yanai, S., & Kurihara, Y., et al (2016). Combined reconstructive surgery involving uterosacral colpopexy and anterior vaginal mesh implantation for pelvic organ prolapse. J. Obstet. Gynaecol. Res., 42 (6), 707-715. DOI: 10.1111/jog.12952.
Campagna, G., Panico, G., Vacca, L., Caramazza, D., Gallucci, V., & Rumolo, V., et al (2020). Laparoscopic sacral colpopexy for pelvic organ prolapse recurrence after transvaginal mesh surgery. Eur. J. Obstet. Gynecol. Reprod. Biol., 248, 222-226. DOI: 10.1016/j.ejogrb.2020.03.025
Naumann, G., Hüsch, T., Mörgeli, C., Kolterer, A., & Tunn, R. (2021). esh-augmented transvaginal repair of recurrent or complex anterior pelvic organ prolapse in accordance with the SCENIHR opinion. Int. Urogynecol. J., 32 (4), 819-827. DOI: 10.1007/s00192-020-04525-9.
Wallace, S.L., Syan, R., & Sokol, E.R. (2019). Surgery for apical vaginal prolapse after hysterectomy: Transvaginal mesh-based repair. Urol. Clin. North Am., 46 (1), 103-111. DOI: 10.1016/j.ucl.2018.08.005
Grinstein E., Gluck O., Veit-Rubin N., & Deval B. (2020). Laparoscopic management of pelvic organ prolapse recurrence after open sacrocervicopexy. Int Urogynecol J., 31 (9), 1965-1968. DOI: 10.1007/s00192-020-04283-8
Caruso, S., Cianci, S., Vitale, S.G., Matarazzo, M.G., Amore, F.F., & Cianci, A. (2017). Effects of ultralow topical estriol dose on vaginal health and quality of life in postmenopausal women who underwent surgical treatment for pelvic organ prolapse. Menopause, 24 (8), 900-907. DOI: 10.1097/GME.0000000000000851
Cho, M.K., Moon, J.H., & Kim, C.H. (2017). Factors associated with recurrence after colpocleisis for pelvic organ prolapse in elderly women. Int. J. Surg., 44, 274-277. DOI: 10.1016/j.ijsu.2017.06.086
Aleixo, G.F., Fonseca, M.C.M., Bortolini, M.A.T., Brito, L.G.O., & Castro, R.A. (2019). Pelvic floor symptoms 5 to 14 years after total versus subtotal hysterectomy for benign conditions: a systematic review and meta-analysis. Int. Urogynecol. J., 30 (2), 181-191. DOI: 10.1007/s00192-018-3811-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Actual Problems of Pediatrics, Obstetrics and Gynecology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
