Correction Of Genital Prolapse Research Articles

Якість життя як критерій ефективності хірургічного лікування генітальних пролапсів, поєднаних із лейоміомою матки

Criteria for choosing the volume of surgical intervention in patients with genital prolapse combined with uterine leiomyoma have not been developed. Purpose - to evaluate quality of life after hysterectomy with and without correction of genital prolapse. Materials and methods. 120 patients were examined. In the Control (I) Group (n=40), hysterectomy was performed without correction of genital prolapse, in the other two groups - hysterectomy and correction of genital prolapse using a mesh implant by the method of pectopexy (the Group II, n=40) or lateral fixation (the Group III, n=40). The PFDI-20, PISQ and PD-QOL questionnaires were used to assess the quality of life after the operation. Statistical analysis was performed with SPSS Version 21.0. Results. Significant differences in the average number of points were registered in the Group II and Group III - 45.39±27.02 and 49.78±17.24 points respectively; p<0.001. The sexual function index also significantly increased: from 18.93±14.61 to 24.85±12.19 points in the Group II and from 17.55±10.64 to 24.30±13.92 points in the Group III (р=0.01). During the analysis 12 months post surgery, attention was drawn to reliable differences in the average estimates of the impact of manifestations of genital prolapse on the quality of life (the PD-QOL questionnaire), physical and social limitations, interpersonal relationships and emotional problems in the Group II/Group III compared to patients in the Group I (p<0.05). Conclusions. The data we obtained allow us to talk about the effectiveness of simultaneous correction of genital prolapse with hysterectomy using mesh implants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Анатомічні та функціональні результати після хірургічного лікування поєднаної лейоміоми матки з генітальним пролапсом

More than 41% of women aged 50-79 suffer from pelvic organ prolapse. Genital prolapse is combined with uterine leiomyoma in approximately 20% of cases, which necessitates a differentiated approach to the treatment. Purpose - to compare the anatomical and functional results of surgical treatment of women with uterine leiomyoma combined with genital prolapse, who underwent hysterectomy with and without prolapse correction. Materials and methods. 80 patients with genital prolapse combined with uterine leiomyoma were examined and divided into three groups. In the Control (I) Group (n=40), hysterectomy was performed without correction of genital prolapse, in the other two groups - hysterectomy and correction of genital prolapse using a mesh implant by the method of pectopexy (the Group II, n=40) or lateral fixation (the Group III, n=40). Anatomical and functional outcomes were assessed 6 and 12 months postoperatively using the POP-Q and the questionnair PFDI-20 and PISQ-12. Statistical analysis was performed with SPSS Version 21.0. Results. In women of the Groups II and III, POP-Q parameters significantly improved 6-12 months after surgery compared to the initial level, while in patients of the Group I, 1 year after surgery, negative dynamics of changes in points Aa, Ba and indicators of pb and Tvl were established. Anatomical success, which is POP-Q stage 0-1 one year after surgery and does not require further surgical treatment, was 82.5% in the Group II and 85% in the Group III. The frequency of improvement of pelvic functions according to PEDI-20 and the state of sexual function according to PISQ-12 6 months after the operation was significantly higher among women of the Groups II and III comparing to the Group I. Conclusions. The obtained data testify to the anatomical effectiveness of simultaneous hysterectomy and correction of genital prolapse using mesh implants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Порівняльна ефективність методів хірургічного лікування генітальних пролапсів, поєднаних із лейоміомою матки

Uterine leiomyoma is combined with genital prolapse in approximately 20% of cases and is probably a risk factor for the latter. Until now, no differentiated approach to the choice of the surgical intervention method of genital prolapses combined with uterine leiomyoma has been developed, depending on the type of prolapse and prolapse of the internal genital organs. Purpose - to evaluate the effectiveness of different operative treatment complex uterine leiomyoma with genital prolapse depending on the type of pelvic organ prolapse. Materials and methods. 80 patients with genital prolapse combined with uterine leiomyoma aged from 34 to 67 years (on average - 50.34±9.46 years) were examined. Depending on the type of the surgical intervention performed, the women were divided into two groups, in each group two subgroups were distinguished regarding the type of genital prolapse. The Group I consisted of 40 women who underwent amputation or extirpation of the uterus and correction of genital prolapse using a mesh implant by the pectopexy method, in the Group II (n=40) - similar operations with prolapse correction were performed by using method of lateral fixation. Ia (n=18) and IIa (n=20) subgroups included patients with cystocele, and Ib (n=22) and IIb (n=20) subgroups comprised of patients with cystocele and/or apical prolapse. To assess the quality of the treatment results, a bimanual examination with a cough test and a Valsalva maneuver, a 2-hour pad test, as well as surveys using the PFDI-20 and PISQ questionnaires were used. Data analysis was carried out using The Statistical Package for Social Sciences (SPSS), version 20.0. Results. According to the PEDI-20 questionnaire, the frequency of pelvic function improvement (an increase of ≥60 points) 6 months after surgery was significantly higher among women of the Ib than Ia subgroup (OR=4.4; 95% CI: 1.13-17.07) and in IIa comparing to IIb subgroup (OR=10.52; 95% CI: 2.27-48.75). Improvement of sexual function (PISQ score from 21 to 30 points) and good/excellent result (PISQ score - >30 points) 6 months after surgery had significantly more patients in the Ib than in the Ia subgroup (OR=7.5; 95% CI: 1.28-44.08) and in IIa comparing to the IIb subgroup (OR=31.2; 95% CI: 3.29-295.3). Conclusions. The highest percentage of positive results of genital prolapse correction by pectopexy was in patients with cystocele and/or apical prolapse, and in the group of prolapse correction by lateral fixation - in patients with cystocele. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Possibilities of quadripolar radiofrequency therapy as a method of rehabilitation after surgery for pelvic organ prolapse

Background. This article is devoted to a topical topic in gynecology genital prolapse and methods of preventing recurrence in the postoperative period. Despite the surgery in the field of correction of genital prolapse, up to 13% of patients require repeated surgical treatment of this pathology in the postoperative period.
 Aim. At present, a unified algorithm for rehabilitation after operations to eliminate this pathology has not yet been developed. We proposed a technique for using quadripolar radiofrequency therapy in patients operated on for pelvic organ prolapse in the postoperative period in order to improve the rehabilitation period.
 Materials and methods. To achieve our goals, histological material was collected from 60 patients with pelvic organ prolapse before and after surgical treatment to assess the strength of collagenogenesis and reparative processes in the connective tissue of the vagina based on changes in the expression of the RNA matrix of collagen types I and III, genes encoding vascular endothelial growth factor VEGF-A, transforming growth factor TGF-B1 and decorin by polymerase chain reaction. The FSFI-19 questionnaire was used to analyze the quality of the patients' sexual life. We also calculated the vagina health index of patients suffering from this disease.
 Results. In the course of the study, it was revealed that when using this method, complete re-epithelization of tissues occurs by 90 days after the operation, metabolic and trophic processes in the tissues of the urogenital tract intensify, and an increased degree of patient satisfaction with the quality of sexual life.
 Conclusion. All the results obtained confirmed the therapeutic effect of radiofrequency therapy in the postoperative period, which makes it possible to use the technique as a rehabilitation program after surgical treatment for genital prolapse.

Experience in surgical correction of genital prolapse caused by abdominoperineal operations for colon cancer in anamnesis

In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.

МЕТОД ХИРУРГИЧЕСКОЙ КОРРЕКЦИИ ПРОЛАПСА ГЕНИТАЛИЙ РАЗЛИЧНОЙ СТЕПЕНИ У ЖЕНЩИН

The article presents the results of reproductive age 126 women survey with genital prolapse receiving treatment in the 3rd maternity complex of the Samarkand city for the period from 2012 to 2016. It has been established that the developed method of surgical correction of genital prolapse with simultaneous transvaginal ligation of the fallopian tubes in women of reproductive age will not only eliminate the main pathology, but also choose the most effective and safe contraception method for women with genital prolapse, reduce treatment time, improve the quality of life, reduce economic costs.

Modern Materials in Surgical Correction of Genital Prolapse

Modern Materials in Surgical Correction of Genital Prolapse

Comparative assessment Of life quality of patients after the correction of genital prolapse with different synthetic implants

There was made a comparative analysis of surgical complications, life quality of patients and also sexual life quality after the correction of genital prolapse with the implants Prosima™ and Prolift™. There were reflected the advantages of the operation when the implants Prosima™ were used while correcting the genital prolapsed of III stage compared with the use of the implant Prolift™. There was shown the success of the operation Prosima™, its safety because of little invasiveness and few number of complications, satisfaction of the patients with the results of the treatment and also the improvement of the life quality and restoration of sexual activity.

Lesser invasive technologies in correction of stress uroclepsia in pelvic prolapse

Conclusion. The optimal way for treatment of patients with pelvic prolapse complicated by cysto- and rectocele is combined operation which makes it possible to carry out correction of genital prolapse (including remodeling of pelvic floor) and to eliminate functional disorders of annexa.

Surgical treatment of prolapse through a laparoscospic retroperitoneal approach: a new route for sacral colpopexy

The retroperitoneal approach was first described and used several years ago for the staging and treatment of gynaecological malignancies, or for Burch laparoscopic colposuspension procedures. We here describe an original technique for the correction of genital prolapse or for performing a laparoscopic sacral colpopexy using a retroperitoneal approach. Our technique involves fixation of the vagina to the sacral promontory using prosthetic material, followed by paravaginal repair and Burch's colposuspension. This route allows for complete treatment of the three components of the pelvic support system and has both advantages and weaknesses. The latter are discussed, followed by suggestions concerning situations where this approach might be preferred to standard techniques.

Correction of genital prolapse.

Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always coexists with other pelvic floor defects. The management is almost always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments, which clearly is not ideal for providing the kind of support needed. Current understanding of the neurophysiology, neuroanatomy, and biophysics of the pelvic floor give us hope that management will be more effective in the future. Laparoscopic repair techniques are described.

Hysterosacropexy for uterine prolapse with associated urinary tract abnormalities

SummaryHysterosacropexy is described for the surgical correction of genital prolapse that develops in association with bladder exstrophy. A synthetic inert graft of Gore-Tex is used to elevate the uterus and fix it to the sacrum, thus conserving the uterus for the repair.