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. 

1. Adjoussou S.A, Bohoussou E., Bastide S., Letouzey V., Fatton B., de Tayrac R. Functional symptoms and associations of women with genital prolapse. Prog Urol. 2014;24(8):511-17. DOI: 10.1016/j.purol.2013.11.015.

2. Ellerkmann R.M., Cundiff G.W., Melick C.F., Nihira M.A., Leffler K., Bent A.E. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185(6):1332-37. DOI: 10.1067/mob.2001.119078.

3. Fritel X., Varnoux N., Zins M., Breart G., Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113(3):60916. DOI: 10.1097/AOG.0b013e3181985312.

4. Буянова С.Н., Мгелиашвили М.В., Петракова С.А., Марченко Т.Б. Особенности лечения больных с тяжелыми и рецидивными формами пролапса гениталий в пожилом и старческом возрасте. Российский вестник акушера-гинеколога. 2015;15(4):81-84. [Buyanova S.N., Mgeliashvili M.V., Petrakova S.A., Marchenko T.B. Specific features of treatment in patients with severe and recurrent genital prolapse in the elderly and senile patients. Rossiyskiy vestnik akushera-ginekologa=Russian Bulletin of Obstetrician-Gynecologist. 2015;15(4):81-84 (in Russ.)]. DOI: 10.17116/rosakush201515481-84.

5. Maher C.M., Feiner B., Baessler K., Glazener C.M. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J. 2011;22(11):1445-1457. DOI: 10.1007/s00192-011-1542-9.

6. Barbalat Y., Tunuguntla H.S. Surgery for pelvic organ prolapse: a historical perspective. Curr Urol Report. 2012;13(3):256-61. DOI: 10.1007/s11934-0120249-x.

7. Дивакова Т.С., Мицкевич Е.А. Пролапс внутренних половых органов и стрессовое недержание мочи у женщин: патогенез, клиника, диагностика, современные подходы к лечению. Репродуктивное здоровье в Беларуси. 2009;(5):21-37. [Divakova T.C., Mitskevich E.A. Prolapse of the internal reproductive organs and stress urinary incontinence among women: pathogenesis, clinic, diagnostics, and modern approaches of treatment. Reproductive Health in Belarus. 2009;(5):21-37 (in Russ.)].

8. Яговдик И.Н., Кузнецов Р.В., Пашенко Е.Н., Качук Н.В., Ступакевич М.Б. Акушерская травма промежности в генезе пролапса гениталий. Репродуктивное здоровье в Беларуси. 2010;(5):57-66. [Yagovdik I.N., Kuznetsov R.V., Pashenko E.N., Kachuk N.V., Stupakevich M.B. Obstetric perineal trauma in the genesis of genital prolapse. Reproductive Health in Belarus. 2010;(5):57-66 (in Russ.)].

9. Ящук А.Г., Мусин И.И., Попова Е.М., Нафтулович Р.А., Зайнуллина Р.М., Имельбаева А.Г. Хирургическое лечение стрессового недержания мочи у женщин с применением коллагенового материала. Экспериментальная и клиническая урология. 2015;(4):124-126. [Yaschuk A.G., Musin I.I., Popova E.M., Naftulovich R.A., Zaynullina R.M., Imel’baeva A.G. Surgical treatment of stress urinary incontinence in women using a collagen material. Experimental and Clinical Urology. 2015;(4):124-126 (in Russ.)].

10. Гутикова Л.В., Нечипоренко Н.А., Зверко В.Л., Колесникова Т.А. Опыт использования синтетических протезов в хирургии генитального пролапса. Репродуктивное здоровье Восточная Европа. 2013;(4):59-63. [Gutikova L.V., Nechiporenko N.A., Zverko V.L., Kolesnikova T.A. Application of artificial prosthetics for surgical correction of colpoptosis and prolapse of genitalia. Reproductive Health. Eastern Europe. 2013;(4):59-63 (in Russ.].

11. Dillon B.E., Seideman C.A., Lee D., Greenberg B., Frohman E.M., Lemack G.E. A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic. J Urol. 2013;189(3):976-9. DOI: 10.1016/j.juro.2012.09.101.

12. Смольнова Т.Ю., Буянова С.И., Савельев С.В., Петрова В.Д. Дисплазия соединительной ткани - как одна из возможных причин недержания мочи у женщин с пролапсом гениталий. Урология. 2001;(2): 25-30. [Smolnova T.Yu., Buyanova S.I., Savelyev S.V., Petrova V.D. Connective tissue dysplasia as one of the expected causes of urinary incontinence in females with genital prolapse. Urologiia. 2001;(2): 25-30 (in Russ.)].

13. Нафтулович Р.А., Хусаинова Р.И., Ящук А.Г., Хуснутдинова Э.К., Масленников А.В. Анализ полиморфных вариантов гена рецептора эстрогенов альфа у больных с семейными формами пролапса женских половых органов. Российский вестник акушера-гинеколога. 2013;(2):26-29. [Naftulovich R.A., Khusainova R.I., Yashchuk A.G., Khusnutdinova E.K., Maslennikov A.V. Analysis of polymorphic variants in the estrogen receptor alpha receptor gene in patients with the familial forms of female genital prolapse. Rossiyskiy vestnik akushera-ginekologa=Russian Bulletin of Obstetrician-Gynecologist. 2013;( 2):26-29 (in Russ.)].

14. Мусин И.И., Ящук А.Г., Казихинуров А.А., Ямалитдинова Р.Р., Ибрагимов Т.Н. Структурное и функционнальное состояние сфинктера мочевого пузыря у женщин в раннем послеродовом периоде. Медицинский вестник Башкортостана. 2014;9(6):86-89. [Musin I.I., Yashuk A.G., Kazikhinurov A.A., Yamalitdinova R.R., Ibragimov T.N. Structural and functional state of bladder sphincter in women in the early postpartum. Bashkortostan Medical Journal. 2014;9(6):86-89 (in Russ.)].

15. Полянин Д.В., Лукач А.А., Коновалов В.И., Соколова Ю.А., Ольховикова С.В., Самойлова Ю.П. Опыт применения сетчатых эндопротезов на современном этапе решения проблемы тазового пролапса. Уральский медицинский журнал. 2010;(3):112115. [Polyanin D.V., Lukach A.A., Konovalov V.I., Sokolova Y.A., Olkhovikova S.V., Samoilova Y.P. The experience of mesh endoprostheses in the present stage to address the pelvic prolapsed. Ural medical journal. 2010;(3):112-115 (in Russ.)].

16. Iglesia C.B. Pelvic organ prolapse surgery: longterm outcomes and implications for shared decision making. JAMA. 2013;309(19):2045-6. DOI: 10.1001/jama.2013.5528.