Послеоперационные рецидивы пролапса тазовых органов и их комбинированная безоперационная коррекция

Abstract

Objective. To study the efficacy and safety of combined (laser + electromyostimulation + pelvic floor muscle training) nonsurgical correction of pelvic organ prolapse (POP) recurrences in the late postoperative period in reproductive-aged, pre- and postmenopausal patients with different types of POP. Patients and methods. A comprehensive clinical examination, surgical treatment, and dynamic outpatient follow-up (at 1, 6, 12, 24, 36, and 48 months) of 523 patients with different types and severity of POP were performed. Disease recurrences were diagnosed in 69 (13.2%) women, 52 of whom underwent a combined non-surgical corrective therapy (laser + electromyostimulation + pelvic floor muscle training) with subsequent efficacy evaluation after 6 and 12 months. Results. Postoperative recurrences of POP were most often observed 12–36 months after surgical intervention using only own tissues (26.6%), less frequently – when synthetic implants were used (12.7%) and, extremely rarely, when titanium endoprostheses were inserted (1.6%). The positive effect of combined non-surgical correction in 32 (61.5%) women was expressed in a lower number and intensity of symptoms, improvement in the quality of life according to the PFDI-20 scale, optimization of gynecological examination data and quantitative parameters according to the POP-Q classification system. Conclusion. Combined non-surgical therapy (laser + electromyostimulation + pelvic floor muscle training) for postoperative recurrences of POP contributed to the optimization of clinical picture, dynamic improvement of the quantitative parameters of postoperative prolapse according to the POP-Q classification system, improvement of the quality of life of women, their social and sexual rehabilitation, which demonstrates the efficacy and safety of the implemented therapeutic program. Key words: postoperative recurrences of pelvic organ prolapse, combined non-surgical therapy, fractional CO2 laser, electromyostimulation, pelvic floor muscle training