Clinical Curative Effects of Three Surgical Procedures in the Treatment of Severe Pelvic Organ Prolapse

Abstract

Objective To evaluate the therapeutic effect of total pelvic floor reconstruction (Prolift), transvaginal hysterectomy (TVH) plus repair of vaginal anterior and posterior wall, and partial colpocleisis on pelvic organ prolapse in the treatment of sever pelvic organ prolapse (POP). Methods From January 2009 to January 2010, fifty-nine patients with sever POP who were admitted into Beijing Obstetrics and Gynecology Hospital were included into this study. They received different operation methods, 22 cases were cured by total pelvic floor reconstruction (3 patients received TVT-O simultaneously, group A), 26 cases were cured by TVH plus repair of vaginal anterior and posterior wall (6 patients received plication operation of urethra simultaneously, group B), and 11 cases were cured by partial colpocleisis (2 patients received plication operation of urethra simultaneously, group C). Intra-operative blood loss, operating time and mean hospital stay were compared among three groups. Patients were received objective assessment [according to pelvic organ prolapse quantitative examination (POP-Q) score] and subjective assessment (Pelvic Floor Distress Inventory Short Form, PFDI-20) by followed-up at 6 months and 12 months after the operation. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal and Child Care Hospital of Fangshan District of Beijing, and Beijing Gynecology and Obsetrics Hospital. Informed consent was obtained from all participates. There had no significant difference between three groups on gravidity, parity and internal medicine complications, and so on (P>0.05). Results ① There had significant difference of operation time among three groups (P 0.05). ② Objective cure rates of group A, B, C were 100.00% (22/22), 90.9%(20/22), 88.89% (8/9), respectively, in six months after the operation, 100.00% (22/22), 86.36% (19/22), and 88.89% (8/9), respectively, in twelve months after the operation.. There had no significant difference of objectively cure rates among three groups (P>0.05). ③Scores of PFDI-20 in three groups at 6 months and twelve months after the operation compared with the preoperative score were significantly different(P 0.05), but after the operation, the score of group B was higher than those of the other two groups (P<0.05). ④ The had significant difference of UDI-6 score before and after the operation in six and twelve months among three groups (P<0.05). ⑤ Patients in group C had no sexual life for over 1 year before operation. In group A, 7 cases (31.82%, 7/22) had sexual life before operation, 5 (22.73%, 5/22) also had sexual life after operation, but 3 (13.64%, 3/22) felt pain in sexual life. In group B, 6 cases had sexual life before operation, 6 cases also had sexual life after operation, 2 felt pain in sexual life. Conclusions Three operation methods are all effective ways in the treatment of sever POP. Prolift is better than transvaginal hysterectomy plus repair of vaginal anterior and posterior wall in objective and subjective cure rate. Partial colpocleisis is a effective way of sever POP for the old patients without sexual life, they can get better quality of life after operation in short period. Key words: total pelvic floor reconstruction; transvaginal hysterectomy plus repair of vaginal anterior and posterior wall; partial colpocleisis