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Background. Ovarian endometriosis has the most aggressive effect on the ovarian reserve compared to other types of benign ovarian neoplasms. Laparoscopic cystectomy with pathomorphological verification remains the gold standard for the diagnosis of endometriosis in clinical practice. It is the lack of clear criteria for predicting damage to the ovarian reserve after surgical treatment and the future reproductive potential of a woman, as well as the inability to personalize treatment, that determined the purpose and objectives of this study. Aims to develop a score scale for predicting changes in the ovarian reserve after cystectomy in ovarian endometriosis based on a comprehensive preoperative assessment of basic clinical, ultrasound, and molecular-biochemical parameters. Materials and methods. A single-center observational cohort prospective comparative study was conducted for 5 years. The study included 238 women aged 24.4 3.1 years with pathomorphologically verified ovarian endometriosis, who came to the clinic with complaints of pain of varying intensity. Results. The content of anti-Muller hormone (AMH) less than 1.5 ng / ml was significantly highly correlated with the unfavorable outcome of surgery (r=0.723). The largest diameter of the formation more than 5 cm (r=0.826) and its main localization (r=0.743) correlated most strongly with a decrease in HR and intraovarian blood flow after cystectomy. The ROC analysis (receiver operating characteristic) and the evaluation of the area under the curve the AUC indicator (area under ROC curve) revealed that the determining value of the cut off point for serum LDH was 107.35 U/l, for IL-8 94.55 pg/ml and IL-6 82.4 pg/ml, with an increase in which the probability of reducing AMH increases by more than 50%. Conclusions. The point scale system including preoperative assessment of ultrasound parameters (endometrioma size, localization, and bilaterality) and biochemical markers of toxicity in serum helps to predict changes of ovarian reserve after cystectomy (LDH, IL-6, IL-8).

Objective. To study and compare the long-term outcomes of surgical correction of cystocele with and without correction of apical prolapse by pectopexy. Design. A prospective study. Patients and methods. A total of 60 patients with cystocele stage 2 or more and apical prolapse stage 1 according to POP-Q (Pelvic Organ Prolapse Quantification System) were examined; 30 patients underwent classical anterior colpoperineorrhaphy and other 30 – combined surgeries, including anterior colporrhaphy and pectopexy. The long-term outcomes of treatment were assessed after 24 months. De novo prolapse stage 2 or more according to POP-Q was considered as prolapse recurrence. Results. The use of pectopexy in the complex surgical treatment of anterior vaginal wall prolapse combined with early stages of apical prolapse (which is not the leading point of prolapse) significantly improved long-term outcomes: 24 months after surgical treatment, cystocele stage 1 was registered only in 13.3% of cases, and 93.3% of patients had no apical prolapse. In the group of patients without pectopexy, progression of apical prolapse to stage 2 was observed in 50% of patients after 24 months. Conclusion. When planning the surgical correction of cystocele, the presence or absence of “hidden” early defects of apical support should be considered. Pectopexy in the correction of apical prolapse combined with cystocele is effective, safe, and pathogenetically sound. Its use improves the long-term outcomes of cystocele treatment and reduces the probability of recurrence. Key words: apical prolapse, long-term treatment outcomes, anterior vaginal wall prolapse, pectopexy, surgical correction, cystocele

Background: Pelvic organ prolapse (POP) is the most frequent disease component in the structure of gynecological pathology (from 28 to 38.9%) and its incidence is increasing. Most of the research studies were initiated to develop various kinds of operative treatment for common prolapse cases (POP-Q III−IV); however, a large number of surgical interventions associated with a high percentage of complications and a high rate of relapses confirm the difficulty for problem-solving. In this regard, there is a need to expand ideas about the pathogenesis of the disease and develop approaches to the prediction of recurrence surgical treatment, choosing the correct and timely treatment strategy. Currently, great importance is given to the study of genetic control of connective tissue metabolism. The evidence demonstrated that polymorphism of NAT2 gene results in genetically determined disorders of connective tissue catabolism which increases the possibility of disease development approximately in 2 times. Point mutations in NAT2 lead to the so-called slow-acetylation which determines the predominance of the decay rate of collagen over its synthesis.Aim: Analyze the significance of NAT2 polymorphism as a predictor for failure of surgical treatment of pelvic organ prolapse.Materials and methods: The prospective cohort clinical trial enrolled 140 women of the reproductive age (from 28 to 42 y.o.) with symptomatic prolapse (POP-Q Stage II−III) who were examined and received treatment in the period from 2008 to 2014. All patients underwent surgical treatment of POP. The treatment included colpoperineorrhaphy with levatorplasty. In 12.9% of patients who had stress urinary incontinence — in combination with a loop urethropexies transobturatory access (Transobturator Vaginal Tape, TVT-O). Long-term results of treatment effectiveness were assessed in 3−5 years. Results: The findings revealed that the incidence rate of point mutations of NAT2 gene was 2-fold higher in patients with POP included in the ineffective treatment group (61.8%) if compared to the rate registered in the effective treatment group (30.6%).Conclusions: The obtained data indicate that the presence of point mutations in NAT2 gene is a poor prognostic factor for general types of genital prolapse and a predictor for failure of surgical treatment.