Abstract
The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.
Highlights
The definition of "genitourinary syndrome" includes a range of manifestations most likely associated with the development of atrophic and dystrophic processes in estrogen-dependent tissues and structures of the lower third of the urogenital tract, as well as in the ligament of the pelvis and pelvic floor muscles [1, 2]
Hysterectomy for uterine fibroids is characterized by hypoestrogenic status, as the uterus with fibroids is a site of local hypoestrodiolemia, and the simultaneous removal of this depot, even with the preservation of ovarian tissue inevitably leads to disruption of steroid homeostasis [3, 4]
Materials and methods of the research In the period from 2015 to 2020, 80 women with symptomatic uterine fibroids who underwent hysterectomy were examined on the basis of the gynecological department of the “Kyiv Perinatal Center”, the period after the operation was 3 years divided into the following groups
Summary
The definition of "genitourinary syndrome" includes a range of manifestations most likely associated with the development of atrophic and dystrophic processes in estrogen-dependent tissues and structures of the lower third of the urogenital tract (lower third of the ureters, bladder, urethra, vagina), as well as in the ligament of the pelvis and pelvic floor muscles [1, 2]. The urgency of this issue is undoubtedly related to the increase in the percentage of such manifestations, the rejuvenation of this condition, and, as a consequence, a significant impact on the quality of life of women. This position is confirmed by the fact that the neurovegetative and vasomotor components of post-hysterectomy syndrome tend to improve even without specific hormone therapy, while the symptoms of genitourinary syndrome persist and progress over time [6, 7]
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