Можливості ультразвукової діагностики генітального пролапса у жінок з екстрагенітальною патологією

Abstract

The purpose of the study was to determine the possibilities of ultrasound examination in improving the preoperative diagnosis of genital prolapse in women with extragenital pathology. Materials and methods. To achieve this purpose, 117 women with genital prolapse were examined, of whom 65 had the disease combined with extragenital pathology (main group), 22 patients had no pronounced extragenital pathology (comparison group), 30 women without signs of gynecological and extragenital diseases made up the control group. To determine the degree of genital prolapse, we used the quantitative assessment system (POP-Q) (1996), performed the levator test, Q-tip test, Bonney test, Valsalva test, uroflowmetry, pelvic ultrasound, in particular transvaginal echography and dopplerometry of the pelvic and perineal vessels using the device “Philips HD 11XE”. Results and discussion. The age of sick women ranged from 55 to 72 years, the average age of women in the first group was 59.2±5.7 years, the second – 60.5±4.5 years, the third – 66.4±3.8 years, the comparison group – 64.6±6.2 years, the control group – 63.8±2.4 years. Attention is drawn to the youngest age in women with diseases of the respiratory system, the oldest – in patients with diabetes mellitus. The duration of the disease ranged from 2 to 10 years (average 7.1±3.5 years). In the control group, the following ultrasound results were obtained: the unchanged pelvic floor was characterized by the symmetry of the anatomical structures, the height of the perineal tendon center (distance from the external anal sphincter to the upper limit of border of the posterior vaginal wall = PB according to POP-Q classification) – 1.2 (1.0-1.4) cm; the thickness of m. bulbocavernosus (in cross section at the level of the upper edge of the external anal sphincter) – 1.5 (1.4-1.6) cm; diastasis of the inner edges of m. bulbocavernosus at the level of the posterior vaginal wall; topography, thickness and structure of m. puborectalis – more than 7 mm. The internal anal sphincter was 0.3 (0.2-0.37) cm, the external anal sphincter – 0.33 (0.27-0.55) cm. Dimensions of the triangle of the urogenital diaphragm were: the length of the base – 5.3 (4.75-6.5) cm; side length – 4.9 (4.8-5.1) cm. In genital prolapse in women with extragenital pathology the following results were obtained: when the genital organs were prolapsed, the height of the tendon center was 0.4-0.9 cm (the norm is more than 1 cm), the diastasis of levator legs – 0-1.1 cm (normally it is not present), the thickness of m. bulbocavernosus – 0.4-1.1 cm (the norm is more than 1.5 cm), the cross-sectional area of m.bulbocavernosus – 1.3-2.4 cm2 (the norm is 2.0-2.4 cm2). With incomplete prolapse of the uterus or the vaginal dome, the height of the tendon center was 0.3-0.7 cm, the diastasis of levator legs – 0.6-3.5 cm, the thickness of the m. bulbocavernosus – 0.4-1.2 cm, the cross-sectional area m. bulbocavernosus – 1.2-2.2 cm2. With complete prolapse of the uterus or the vaginal dome, the height of the tendon center was 0.0-0.5 cm, the diastasis of levator legs – 1.0-3.3 cm, the thickness of m. bulbocavernosus – 0.4-1.3 cm, the cross-sectional area of m.bulbocavernosus – 1.2-2.2 cm2. Ultrasound with the help of load tests (Valsalva test) makes it possible to observe in real time the displacement of organs and tissues of the small pelvis, deviations from the normative indicators, which allows to properly form a plan for surgical correction. Conclusion. Genital prolapse is common in women with extragenital pathology, in particular with bronchial asthma, diabetes mellitus, obesity. Modern possibilities of ultrasound examination allow to use them in improving the preoperative diagnosis of genital prolapse in women with extragenital pathology to increase the effectiveness of treatment