Comparative efficacy оf non-surgical correction of early-onset genital prolapse based on differentiated approach

Abstract

The paper presents the results of the comparative efficacy of non-surgical correction of early-onset genital prolapse (GP) in women of perimenopausal and menopausal age using differentiated approach. The objective: to study morphological traits of the vaginal walls and to compare the effectiveness of non-surgical techniques of GP correction. Materials and methods. The study involved 120 patients with early-onset GP. The treatment group (Group 1) consisted of 90 women with GP who were divided into three subgroups depending on the non-surgical correction technique chosen (utility model patent No.145380 from 10.12.2020): 1a (n=30) – GP correction by platelet-rich autoplasma, 1b (n=30) – GP correction by hyaluronic acid-based agent, 1c (n=30) GP correction using СО2 laser radiation. The experimental group (Group 2) consisted of 30 patients who underwent GP correction by training the pelvic floor muscles individually according to the standard method.Results. Three months after the treatment according to the patented method, the number of patients with GP of grade 2 decreased by 16.7% in group 1a, by 31.3% in group 1b and by 41.2% in group 1c. In patients of 1c subgroup, where the presence of the combined type (cystorectocele) of GP prevailed, in 19 women (63.3%) after the treatment there was an improvement in the morphological structure of the vaginal wall, which was manifested by a pronounced diffuse improvement in angiogenesis (in all layers) due to neoangiogenesis, preserved structure of collagen fibers with increasing density of the latter in the absence of signs of edema and mild degenerative changes. It should be noted that in subgroup 1b, three months after the treatment 17 (56.6%) women had no complaints which was associated with a significant improvement in the indicator of the size of elastin and collagen fibers, and only in 9 patients (30%) this indicator remained without changes. In subgroup 1a, the evaluation of the effectiveness of the non-surgical technique showed that only 10 (33.3%) women had a slight improvement in quality of life compared to baseline before treatment. In the experimental group, there was no positive dynamics, and in 9 women (30%) three months after the treatment there was an increase in manifestations of GP and symptoms associated with it, which was confirmed by such morphological changes as minimal focal signs of neoangiogenesis, thinned, significantly swollen collagen fibers, surrounded by interlayers of connective tissue.Conclusions. This algorithmic approach in non-surgical correction of GP contributes not only to the effective treatment of early-onset GP, prevention of further progression, but also to a significant improvement in quality of life.