Surgical Correction Of Genital Prolapse Research Articles

Combined treatment of postmenopausal patients with pelvic organ prolapse and genitourinary syndrome

Background. Colpoptosis combined with stress urinary incontinence is one of the most common conditions in postmenopausal women. Menopause is also associated with the risk of genitourinary syndrome due to estrogen deficiency. Despite the variety of options for surgical correction of genital prolapse and urinary incontinence, there is no universal technique. The use of vaginal approach in pelvic floor surgery is associated with several controversies regarding the rates of recurrence and mesh-associated complications. Studies of the state of the endothelium in menopause have demonstrated a close relationship between age-related features and the frequency of adverse clinical outcomes, which requires an optimal intervention not only on the hormonal status but also on the microcirculatory system. Aim. To improve the principles of complex treatment of pelvic organ prolapse and genitourinary syndrome in postmenopausal patients. Materials and methods. The study included 48 postmenopausal patients with genital prolapse of stage II and above according to the POP-Q classification. All patients received continuous menopausal hormone therapy (MHT) with a combined estrogen-progestogen agent. The patients in group 1 (n=24) received MHT according to clinical guidelines for managing patients with genitourinary syndrome. The patients in group 2 (n=24), in addition to MHT, received sulodexide containing glucurono-2-amino-2-deoxyglucoglucan sulfate before the intended surgical treatment and for 30 days after surgery. Correction of colpocystocele, proctocele and stress urinary incontinence was performed using anterior and posterior colporrhaphy, perineoplasty, and urethral sling placement in case of stress urinary incontinence. Results. Six months after surgical treatment, signs of genital prolapse recurrence were detected in 3 patients (12.5%) in group 1, and 1 patient (4.2%) showed signs of mesh-associated complications (implant extrusion) after urethral sling placement. In group 2, only 4.2% of patients (n=1) showed signs of recurrence of stage II cystocele. All patients who underwent urethral sling surgery reported improved urinary incontinence (n=10). During complex therapy, 3 months after surgery, a more significant improvement of endothelial dysfunction markers was noted in group 2 patients (homocysteine level in group 1 after treatment was 12.27±0.34, in group 2 – 8.34±0.24). Conclusions. Combination therapy of genitourinary syndrome and genital prolapse using MHT, endotheliotropic drugs and vaginal surgical approach in postmenopausal patients contributes to effective and safe treatment associated with minimal risk of complications and recurrence rate. Endothelial dysfunction correction is an essential step in planning surgical intervention in menopausal patients, which contributes to improving tissue repair in the postoperative period.

Сравнительная оценка хирургических методов лечения пролапса гениталий у женщин репродуктивного возраста лапароскопическим доступом

An urgent problem at present is an increasing number of women of reproductive age with pelvic floor muscle failure. The purpose — to evaluate the results of organ-preserving surgical correction of genital prolapse in women of reproductive age. Material and methods. This article describes the results of observations in 17 patients of reproductive age with genital prolapse. All patients were assessed for gynecological, somatic status, as well as the severity of connective tissue dysplasia, sexual activity, and anamnesis. The women were divided into two groups: the first group underwent laparoscopic uteropromontopexy with suturing of sacro-uterine ligaments to promontory; the group underwent a two-level laparoscopic uteropromontopexy with suturing of sacro-uterine and cardinal ligaments to promontory. We evaluated both the immediate and long-term results of the correction. Results. The study confirmed that the two-level promontofixation should be considered the main method of surgical treatment of genital prolapse in women of reproductive age. Conclusion. Careful diagnosis in the preoperative period and the presence of connective tissue dysplasia allows one to predict the likelihood of a genital prolapse recurrence and choose a specific method of surgical correction.

Modern aspects of the fascial structure of the pelvic floor (literature review)

The pelvic floor fascia in women has attracted the attention of obstetricians-gynecologists, proctologists and rehabilitologists due to their possible role in the development of pelvic organ prolapse and the appearance of pelvic pain. The development and improvement of new surgical techniques entails a comprehensive study of previously known approaches. For instance, regarding fascial tissues, studying the actual use of fascial flaps in plastic and reconstructive surgeries is of particular interest. This necessitates an accurate definition of and knowledge about structure of the fascia and their variations. In addition, knowledge of the fascial structure of surgical methods for treating prolapse, such as the installation of mesh prostheses in the reconstruction of the pelvic floor in the absence of alternative methods of correction. Primarily postoperative pain, a more in-depth study of the fascial anatomy of the pelvic floor can help reduce these adverse outcomes. The morphological and physiological characteristics of the perineal fascia presented in the teaching materials and teaching aids are not descriptive in nature and are far from the descriptive practice of obstetricians-gynecologists in the selection of methods for surgical correction of genital prolapse. This work is a literature review compiled from the sources of the electronic national bibliographic database of scientific citation of the Russian Science Citation Index and the English-language text database of medical and biological publications PubMed, created by the National Center for Biotechnological Information of the USA. To search for data, such key queries as fascia, pelvic floor, pelvic floor anatomy, genitourinary diaphragm, chronic pelvic pain were used, both individually and collectively.

Comprehensive management of patients with pelvis organ prolapse and metabolic syndrome

Background. Genital prolapse (GP) and stress urinary incontinence (SUI) are characterized by a failure of connective tissue skeleton of the pelvic floor structures, and there are many risk factors in their pathogenesis. Metabolic syndrome (MS), which includes obesity and abnormalities in the lipid and carbohydrate profile, contributes to the initiation of pelvic organ prolapse (POP) due to increased intra-abdominal pressure and the presence of comorbidities. Endothelial dysfunction associated with MS aggravates the existing metabolic disorders, resulting in the formation of a vicious circle and an increase in the likelihood of recurrence of genital prolapse symptoms and НМ during tension in the postoperative period. Aim. The search for rational algorithms for the comprehensive management of patients with POP and MS. Materials and methods. A comparative analysis of effectiveness of treatment with the use of surgical method or drugs which affect the metabolic profile in patients with GP and SUI was carried out. Results. Drugs which contribute the restoration of lipid and carbohydrate profiles, and microcirculatory vasculature normalization, attenuate negative effects of MS components on the integrity of pelvic floor structures. Comprehensive management of patients with POP and MS with surgical correction of GP and SUI, as well as the use of drugs affecting metabolism, is highly effective and predictive in regard to POP severity and the risk of recurrence of clinical symptoms in the postoperative period. Conclusion. Adequate restoration of the endothelial layer in patients with pelvic floor muscle incompetence and endothelial dysfunction reduces the likelihood of developing mesh-associated complications after the surgical stage of treatment.

Usage evaluation of the biofeedback and electrical impulse stimulation of the pelvic floor muscles in patients after surgical correction of genital prolapse by the method of multi-parametric ultrasound

To evaluate the effectiveness of biofeedback therapy and EIS of the neuromuscular apparatus of the pelvic floor in patients operated on for stage III, IV of genital prolapse using mesh implants by means of validated questionnaire survey and measuring the parameters of perineal tissues by the method of multi-parametric ultrasound. The study included 187 women after surgical correction of stage III and IV genital prolapse according to POP-Q using mesh technologies. The 149 women underwent the observation program; 36 patients of the control group were recommended to modify their lifestyle; 113 patients of the main group - biofeedback therapy and EIS. The indicators of validated questionnaires (determination of the of perineal structures failure influence index on the life quality, ILQ) and ultrasound multi-parametric examination were assessed at baseline, 6 months and 1 year after the program of observation and rehabilitation. The clinical effectiveness of biofeedback therapy and EIS was confirmed by validated questionnaire: after 1 year, the ILQ in the control group decreased by 7.7%, in the main group - by 43.3% (p<0.05). Multi-parametric ultrasound assessment of perineal tissues after surgical correction of stages III and IV of genital prolapse showed a positive effect of conservative rehabilitation on the anatomical and functional structures of the pelvic floor. The diagnostic advantage of endo-anal sonography in the analysis of the echo-structure of the pelvic floor elements, detection of pathologies that cannot be scanned endo-vaginally and trans-perineally has been established. There were 2 (5.5%) cases of recurrence of genital prolapse in the control group; there were no relapsesamong the patients of the main group. The validated questioning for the ILQ and ultrasound multi-parametric study by measuring the parameters of perineal tissues confirmed the effectiveness of biofeedback therapy and EIS after surgical correction of stage III and IV genital prolapse using mesh technologies. Endo-anal sonography is essential in the examination of gynecological patients. The adherence to the monitoring and rehabilitation program was 79.6%.

Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence

Normal vaginal microflora consists of a wide range of microorganisms that maintain optimal vaginal milieu, preventing the development of infectious and inflammatory diseases of the vulva and vagina. However, the use of drugs, changes in hormonal status, urinary incontinence and pelvic floor dysfunction can disrupt the optimal balance of the vaginal microbiota, which leads to the development of dysbiotic pathological processes. The first-line treatment for stress urinary incontinence is the installation of suburethral slings. If incontinence is combined with a cystocele, it is advisable to perform reconstructive surgery for anterior vaginal wall, which has high both anatomical and functional efficacy. Surgical correction of genital prolapse and stress urinary incontinence requires bladder catheterization, which further increases the risk for dysbiotic and inflammatory diseases of the urogenital tract. The widespread use of antibiotic therapy leads to the formation of resistant strains of microorganisms and is not always fully realized, especially in the presence of post void residual urine in the postoperative period. Vaginal Zalain suppositories are highly sensitive to Candida species, and the use of Zalagel Intim gel is associated not only with antifungal, but also anti-inflammatory effect. Complex therapy with Zalain suppositories and Zalagel Intim gel is highly effective in the treatment of cytolytic, bacterial vaginosis, vulvovaginal candidiasis, and can also be used as the prevention of infectious complications after corrective interventions for pelvic organ prolapse and stress urinary incontinence.

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.

Possibilities of using the SMARTXIDE2 V2LR laser system after reconstructive plastic surgery with use mesh prostheses for genital prolapse

Introduction. Prolapse of pelvic organs is a polyetiological disease, manifested by a displacement of the uterus and he vaginal walls to the genital slit and/or by going beyond it. The urgency of the problem of prolapse of pelvic organ is associated with a tendency for an increase of morbidity in both elderly women due to increased expectancy of life and women of the reproductive period.&#x0D; Material and methods. The study included 62 patients, age of them was 4275 years. All women were underwent surgical correction with a transvaginal installation of the front mesh implant Gineflex with intraoperative extraction of fragments of the mucous membrane of the anterior wall of vagina with subsequent histological examination, as well as fragments of the mesh prosthesis after its installation and processing of the vaginal mucosa of the SmartXide2 V2LR laser system. Patients were separated on the two group taking into account the operating mode parameters of the fractional CO2 laser. In the 1st group, with a total laser energy of exposure 8.13 J/cm2, included 32 patients, in the 2nd, with a total laser energy of impact 1.48 J/cm2, 30 patients. Transvaginal installation of the anterior mesh prosthesis Gineflex was complemented such the surgical interventions as extraperitoneal ligature hysterosuspension, posterior colporography, colpoperineoplasty, installation of Urosling, Manchester operation, supravaginal uterine amputation, adnexectomy in depending on the accompanied pathology.&#x0D; Results. In the patients were determined IIIV stages of genital prolapse with using the POP-Q assessment system. During histological examination of a sample of biopsy of the vaginal mucosa, the thickness of walls ranged from 155 to 628 m. During microscopy on fragments of mesh prostheses in the 1st group, fragmentary destruction of the fibers of all formed was noted, which not have been detected in the examination of a samples of patients of the 2nd group, where the total laser energy was less on 6.65 J/m2.&#x0D; Conclusion. In patients with surgical correction of genital prolapse with using of a mesh implant upon the using the certain characteristics of SmartXide2 V2LR laser system for the exposure of the vaginal mucosa occurs partial destruction of the fibers of the mesh prosthesis, which allows to reduce the degree of tissue tension and consequently allows to reduce the level of complications after surgical diseases is associated with implantation a mesh prosthesis that does not reduce the effectiveness of this surgical treatment. This technique is safe, has no restrictions on the age and somatic status of patients, increases the tolerance of the postoperative period of surgical correction.

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.

Three-component local therapy for genitourinary syndrome of menopause in womenwith surgical correction of genital prolapse

Three-component local therapy for genitourinary syndrome of menopause in womenwith surgical correction of genital prolapse

Modern Materials in Surgical Correction of Genital Prolapse

Modern Materials in Surgical Correction of Genital Prolapse

SURGICAL TREATMENT AND PROPHYLAXIS OF PROLAPSE OF GENITALS IN DIFFERENT AGE GROUPS

Introduction. According to WHO up to 50-60% of women in postmenopause suffer from prolapse of genitalia. Wherein as a rule this state is accompanied with a number of anatomic and functional disorders: primarily obstructive uresis or enuresis, overactive bladder, defecatory disorder, gamic disorder, and also permanent sense of discomfort and heaviness in perineal region. In connection therewith, the main objective of the research was to evaluate the results of surgical correction of genital prolapse using differentiated approaches to the management through up-to-date methods to morphologically assess the device that immobilize the uterus. Materials and methods. The article presents the results of a study of 203 patients with genital prolapse II-IY stages, which were divided into 2 groups: the first group included 45 patients of reproductive age from 35 to 45 years, and the second group consisted of 158 patients, aged 45 to 60 years, who underwent pelvic floor reconstruction, vaginal hysterectomy with the use of endoscopic techniques in combination with urethropexies mesh material, salvageable, including using titanium metallicity. As to justify surgical correction, patients in the second group were conducted histological analysis of the round uterine ligaments, the cardinal ligaments of the uterus and the Sacro-uterine ligaments. Patients were examined after 6, 12, 24, 36 months after the complex treatment. Results. It was found that in patients of reproductive age with unfulfilled reproductive function of type of surgical treatment is considered only in combination with urethropexies mesh or collagen material. Conclusion. To reduce the risk posthysterectomy prolapse requires a comprehensive diagnostic anatomical and functional disorders of pelvic organs and pelvic diaphragm in the preoperative period, which determines the access, the scope of surgical intervention and allows to minimize both operational and postoperative complications.

Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review

Urodynamic investigations have been advocated to be incorporated in the standard diagnostic workup of patients undergoing surgical correction of genital prolapse. Stress incontinence is reported by 40% of patients with genital prolapse. Urodynamic stress incontinence (USI) is diagnosed in 70-75% of these patients. Occult urodynamic stress incontinence (OUSI) is diagnosed in about 50% of the patients with genital prolapse not reporting stress incontinence before surgery. Performing urodynamic investigation in patients undergoing prolapse surgery may be valuable if diagnosing USI or OUSI results in the selection of the optimal treatment strategy. This treatment strategy is either a combination of prolapse and stress incontinence surgery or prolapse surgery at the beginning and re-evaluation of possible stress incontinence afterwards. The combination of prolapse and stress incontinence surgery has the advantage of attempting to solve two problems at the same moment, but carries an increased risk on unwanted side-effects, of which, voiding dysfunction and detrusor overactivity are the most important. This review presents a literature overview of what has been proven about the diagnostic and therapeutic value of urodynamic investigations in patients undergoing prolapse surgery.

Laparoscopic Treatment of Pelvic Floor Defects in Women of Reproductive Age

Study Objective To evaluate the efficacy of conservative laparoscopic treatment of genital prolapse in women of reproductive age. Design Retrospective analysis (Canadian Task Force classification II-2). Setting University hospital, Center of Reconstrutive Pelivc Endosurgery, Reproductive Medical Unit, S. Orsola Hospital, Bologna, Italy. Patients Patients. Fifteen women of reproductive age with genital prolapse. Intervention Interventions. Conservative laparoscopic surgical correction of genital prolapse. Apical prolapse was corrected by sacral colpohysteropexy. Burch colposuspension was always included to treat evident or latent stress urinary incontinence. Anterior compartment defects were treated by laparoscopic paravaginal repair and by the interposition of an intervesicouterine prosthesis. Posterior compartment defects were corrected by a prosthetic reconstruction of the rectovaginal support structure. Measurements and Main Results Measurements and Main Results. All patients underwent surgery between January 1998 and December 2000. They were prospectively evaluated for a minimum of 24 months of follow-up. No woman underwent additional surgery during the follow-up period. All women had resolution of the apical prolapse. In one woman, anterior compartment correction (i.e., correction of the anterior part of endopelvic fascia, including correction of bladder and anterior vaginal wall prolapse) was reported. No woman underwent additional prolapse surgery during the follow-up period. Three women became pregnant after surgery: one had an abortion at 8 weeks' gestation; the other two completed term pregnancies and delivered by cesarean section. Conclusion Laparoscopic therapy of genital prolapse is a desirable procedure in patients of reproductive age because it respects the anatomic structures and maintains the function of the organs. Furthermore, laparoscopic treatment is feasible and well-tolerated and produces good results.

The urinary bladder of a woman is a novel site of luteinizing hormone–human chorionic gonadotropin receptor gene expression

Objective: The female reproductive tract contains functional luteinizing hormone–human gonadotropin receptors; therefore our objective was to test the hypothesis that bladder trigone, which is derived from intermediate mesoderm along the urogenital ridge during embryonic development of the female reproductive tract, may also contain these receptors. Study Design: Bladder trigones or domes were biopsied from 15 premenopausal and 19 postmenopausal women undergoing surgical correction of genital prolapse, incontinence, or both. The biopsy specimens were submitted for luteinizing hormone–human chorionic gonadotropin receptor analysis by in situ hybridization and immunocytochemical examination. The receptor immunostaining was visually scored by 3 investigators without knowing the identity of the menopausal status. Results: In situ hybridization demonstrated the presence of receptor transcripts, and immunocytochemical examination revealed the presence of receptor protein in bladder trigone. The bladder trigones from postmenopausal women contained lower levels compared with those from premenopausal women, implying that luteinizing hormone might down-regulate its own receptors. Transitional epithelium contained the highest receptor levels followed by smooth muscle and blood vessels. The bladder dome contained receptor levels similar to those in trigone, which suggests that a common embryologic origin is not the only reason for bladder trigone containing the luteinizing hormone–human chorionic gonadotropin receptors. Rather, they are present because luteinizing hormone–human chorionic gonadotropin may regulate bladder functions in women. Conclusions: A woman’s urinary bladder, which has never been thought of as a gonadotropin target, has now been demonstrated to contain luteinizing hormone–human chorionic gonadotropin receptors. These findings suggest for the first time that gonadotropins directly regulate bladder functions in women. (Am J Obstet Gynecol 1998;179:1026-31.)

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.

Local analgesia for surgical cure of prolapse in elderly or unfit women.

Surgical correction of genital prolapse under local analgesia in elderly or unlit women is described. One hundred patients undergoing such surgery between 1972 and 1984 were reviewed. Eighty-five per cent were more than 60 years of age. Over 50 per cent had Fothergill repairs. Ninety-six per cent were assessed as having a good result. The incidence of postoperative complications was 20 per cent and there was no mortality. From our experience the technique seems to be a safe and worthwhile procedure.