Роль ультразвукового исследования в оценке эффективности лечения пациенток с сочетанными формами пролапса тазовых органов и инконтиненции

Abstract

Objective. To analyze the results of pelvic ultrasound before and after the installation of mesh implants to increase the effectiveness of treatment of pelvic organ prolapse (POP) and urinary incontinence. Patients and methods. The study included 96 patients aged 37 to 73 years with a second- and third-degree POP who underwent reconstructive surgery of POP with the installation of mesh implants. In addition to POP, the majority of patients (71.9%) had some form of incontinence during the perioperative period. In 4.2% of patients, incontinence was latent and manifested itself only in the conditions of pelvic organ displacement. Ultrasound markers of incontinence were assessed in the postoperative period: α-angle – between the longitudinal axis of the urethra and the vertical axis of the body, β-angle – between the longitudinal axis of the urethra and the posterior bladder wall. Results. According to the results of ultrasound, which was performed on days 3-5 after surgery, the correction of α- and β-angles to normal values was achieved in 100% of cases regardless of the implant type. The assessment of long-term outcomes (6–21 months) showed that complete clinical and ultrasound effects were achieved in 92.7%, incomplete – in 7.3% of cases. In 7.3% of patients with recurrent POP, ultrasound results revealed abnormalities (abnormal α- and β-angle values) 3-6 months earlier than during the gynecological examination. Stress urinary incontinence (SUI) was relieved in 62.2% of patients. The installation of mesh implants in patients with SUI and overactive bladder (OAB) did not relieve urge incontinence, despite the α-angle values at ultrasound being close to normal. In 4.2% of patients with perioperative latent incontinence, which was diagnosed only by ultrasound, clinical symptoms of incontinence appeared after reconstructive surgery. Conclusion. Ultrasound is an informative method for diagnosing POP and various types of incontinence. Based on objective parameters (α- and β-angle) it is possible to assess the effectiveness of mesh implant installation in peri- and postoperative periods, diagnose hematomas as the cause of dysuric disorders, and identify ultrasound markers of incontinence. Key words: pelvic organ prolapse, stress urinary incontinence, ultrasound examination, surgical treatment