Treatment of genital prolapse in elderly women with genitourinary infection

Abstract

Relevance of the study. Genital prolapse (GP) is a disease that unites a group of disorders of the muscular and ligamentous apparatus of the uterus and vagina, which lead to prolapse and prolapse of the internal genital organs. The incidence of HP in women over 50 reaches 50%, and among elderly and senile women, it increases to 60-70%. Frequent recurrence and the development of septic complications are characterised by urinary tract infections that occur against the background of genital abnormalities, hormone deficiency in the postmenopausal period, diabetes mellitus, asymptomatic bacteriuria, neurogenic bladder dysfunction, urinary incontinence, and surgical interventions on the genital or urinary system.The aim of the study is to optimize the treatment of genital prolapse (GP) in elderly women with urinary and genital infections. Materials and methods. We examined 70 elderly patients, including 20 (28.6%) with GP and infectious lesions of the urinary and genital organs (main group), 30 (42.8%) with GP without infectious lesions of the urinary and genital organs (comparison group), 20 (28.6%) women without gynaecological diseases and extragenital pathology (control group). The severity of the inflammatory process was assessed based on the study of complaints, anamnesis, and laboratory results. The degree of GP was determined using the POP-Q quantitative assessment system. The surgical intervention included transvaginal extirpation of the uterus without appendages, anterior colporrhaphy, colpoperineorrhaphy with levatoroplasty, and sacrospinal colpopexy. Before using the «Polymesh» synthetic mesh endoprosthesis, in order to minimise infectious complications caused by the use of synthetic prostheses, hydrodissection was performed with 0.9% sodium chloride saline (200 ml) with the addition of a third-generation cephalosporin antibiotic (1 g). Results of the study. Patients underwent uterine extirpation without vaginal appendages, unilateral sacrospinal colpopexy, anterior colporrhaphy, colpoperineorrhaphy with levatorrhaphy (in 6 (30%) women of the first group and 13 (43%) - of the second group). Uterine extirpation without vaginal appendages, sacrospinal colpopexy on the left using the «Polymesh» mesh prosthesis, anterior colporrhaphy, colpoperineorrhaphy with levatoroplasty - in 14 (70%) women of the first group and 17 (57%) of the second group. In case of stress urinary incontinence, a mid-urethral sling procedure was additionally performed (6 patients in the first group and 5 in the second). Women with genitourinary infection mainly underwent transvaginal uterine extirpation with unilateral sacrospinal colpopexy and the use of a synthetic mesh prosthesis «Polymesh». The volume of the operation in the form of uterine extirpation using the «Polymesh» prosthesis is due to the reliable effect of the mesh prosthesis in order to prevent the recurrence of the disease compared to sacrospinal colpopexy (1/4% of cases). Conclusions. Surgical treatment of genital prolapse in women with infectious lesions of the urinary and genital organs by using the «Polymesh» mesh prosthesis for colposacropexy after transvaginal uterine extirpation increases the effectiveness of its treatment, reducing the number of recurrences of the disease.