Сравнительный анализ эффективности различных методик хирургической коррекции переднего пролапса II–III степени

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Objective. To conduct a comparative analysis of the efficacy of different surgical techniques for the correction of grade II–III anterior vaginal wall prolapse in sexually active patients of reproductive and perimenopausal ages. Patients and methods. The study included 79 patients of reproductive and perimenopausal ages with grade II–III anterior vaginal wall prolapse. All patients were divided into three groups depending on surgical technique: group 1 (n = 25) – surgical correction of prolapse using titanium mesh implants and 4 soft tissue fixators (“anchors”) according to the developed original technique; group 2 (n = 26) – surgical correction of prolapse using standard polypropylene implants; group 3 (n = 28) – correction with native tissues only. Results. At 1 month after surgery, about 50% of patients in each group reported irregular crampy pain in the inguinal and femoral region and/or perineum. Frequent urination was observed in 20% of patients in group 1, in 23% in group 2 and in 21.4% in group 3. At 6 and 12 months after surgery, 19.2% of patients in group 2 complained of bloody vaginal discharge, vaginal discomfort, painful intercourse, and partner’s negative reaction due to painful intercourse. Gynecological examination revealed erosion in the anterior vaginal wall and endoprosthesis extrusion, which required partial excision of the implant followed by restoration of the integrity of the anterior vaginal wall. Recurrence of grade II–III genital prolapse was diagnosed in 24–36 months in 25% of patients in group 3, in 7.7% in group 2, and in 1 (4%) in group 1, which did not require repeat surgical intervention. Conclusion. The use of individually sized titanium mesh implants together with titanium fixators (“anchors”) for the correction of grade II–III anterior vaginal wall prolapse is preferable to other surgical techniques. Key words: grade II–III anterior vaginal wall prolapse, surgical correction, titanium and polypropylene mesh implants, reproductive and perimenopausal period, mesh-related complications, disease recurrence