Срединная кольпорафия как способ коррекции пролапса гениталий у пациенток пожилого и старческого возраста.

Abstract

Introduction. The problem of genital prolapse (PG) remains relevant due to its high prevalence, reaching its maximum frequency in elderly women. When choosing surgical treatment of PG in the elderly and senile, it is necessary to take into account the presence of extragenital pathology and the somatic status of the patient. One of the methods of PG correction is median colporaphy, which has a high safety profile and a low recurrence rate. The aim of the study was to evaluate the results of median colporaphy in elderly and senile patients with genital prolapse. Materials and methods. The study included 40 women aged 65 years and older with symptomatic PG III-IV degree (POP-Q), who did not have sexual intercourse and did not seek it in the future, who underwent median colporaphy using the Lefor-Neugebauer technique in combination with colpoperineolevatoroplasty. The results of surgical treatment were evaluated according to the following criteria: duration of surgery, intra- and post- operative complications, assessment of the degree of PG before and after surgery, functional and anatomical results of surgery, duration of hospital stay, assessment of symptoms of PG before and after treatment. The follow-up period for patients is from 1 to 5 years after surgery. Results. The average duration of surgery is 41.5±9.6 minutes. The average volume of intraoperative blood loss was 55.5±20.1 ml. One intraoperative complication was registered – damage to the bladder wall. The average length of hospital stay is 5.6±1.0 days. No recurrence of PG was noted. Ac- cording to The Overactive Blade Questionnaire (OAB-q), there was an improvement in the average score from 9.9+6.0 to 7.3+2.7, which indicated a decrease in the severity of PG symptoms. The frequency of dysuric phenomena after surgery decreased by 2.2 times. Urinary disorders after surgery were detected in 15 (37.5%) patients; stress urinary incontinence – in 9 (22.5%) patients, in 6 (15.0%) – de novo, imperative urinary incontinence de novo – in 1 (2.5%) case. According to the Pelvic Floor Distress Inventory questionnaire (PFDI-20), there was a decrease in symptoms and func- tional disorders of the bladder and intestines in patients: a decrease in the number of points on the POPDI-6 scale from 62.1+18.9 to 1.4+3.7; CRAD-8 – from 18.0+14.8 points to 0.7+2.1; UDI-6 – from 29.9+23 to 7.1+10.2. According to an oral survey, all 40 (100%) patients would agree to undergo this operation again and not a single patient regretted the loss of sexual function. Conclusions. Median colporaphy is a safe and effective way to correct genital prolapse in elderly and senile women, including those with a burdened somatic status, who agree to give up vaginal intercourse. It is necessary to carefully inform patients about the irreversibility of vaginal obliteration and about the possible occurrence of dysuric phenomena after surgery.