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Aim: to increase the clinical effectiveness and safety of apical prolapse treatment by applying anterior bilateral sacrospinous fixation (SSF) with a polypropylene mesh implant.Materials and Methods. A single-center open prospective comparative clinical study in parallel groups in parallel groups was carried out at the Clinic of Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. There were examined and treated 155 patients with stage II–IV symptomatic genital prolapse according to the Pelvic Organ Prolapse Quantification System (POP-Q) who underwent various variants of SSF. The patients were stratified into 3 groups: group 1 (LPSSF) – 34 patients with symptomatic apical genital prolapse who underwent SSF through the posterior vaginal wall using LPSSF ligatures (ligature posterior sacrospinous fixation); group 2 (LASSF) – 42 patients with symptomatic apical or anterior-apical genital prolapse, who underwent ligature SSF using the anterior approach LASSF (ligature anterior sacrospinous fixation); group 3 (MESH TASSF) – 79 patients with symptomatic apical or anterior-apical genital prolapse, who were treated by applying the anterior bilateral SSF method using synthetic tape MESH TASSF (tape anterior sacrospinous fixation). The frequency of intra- and postoperative complications, patient complaints, and relapse rates were assessed post-surgery. Functional outcomes were assessed using the PFDI-20 questionnaire (Pelvic Floor Distress Inventory-20) at 3, 6 and 12 months after treatment. Patients in group 3 were treated by applying a method we developed for correction of apical genital prolapse and concomitant cystocele reconstruction.Results. The method presented here was characterized by a lower blood volume loss compared to posterior SSF, minimized intra- and postoperative complications: decreased incidence of hematomas, buttock pain, rate of urinary disorders (stress incontinence, mixed forms of urinary incontinence, urgent urinary incontinence, urinary difficulty, bladder hypotension). Applying MESH TASSF fixation allowed to decrease duration of hospital treatment and alleviate pain severity in the postoperative period, and additionally contributed to improved patients' quality of life sustained for as long as 12 months post-surgery.Conclusion. The treatment results confirmed that the MESH bilateral SSF method using an anterior approach is clinically effective, relatively safe, and contributes to a markedly reduced rate of disease relapses. The presence of anterior-apical or apical genital prolapse (C or Ba+C prolapse, stages II–IV according to the POP-Q) should be considered as indications for performing anterior bilateral SSF.
Aim: to increase the clinical effectiveness and safety of apical prolapse treatment by applying anterior bilateral sacrospinous fixation (SSF) with a polypropylene mesh implant.Materials and Methods. A single-center open prospective comparative clinical study in parallel groups in parallel groups was carried out at the Clinic of Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. There were examined and treated 155 patients with stage II–IV symptomatic genital prolapse according to the Pelvic Organ Prolapse Quantification System (POP-Q) who underwent various variants of SSF. The patients were stratified into 3 groups: group 1 (LPSSF) – 34 patients with symptomatic apical genital prolapse who underwent SSF through the posterior vaginal wall using LPSSF ligatures (ligature posterior sacrospinous fixation); group 2 (LASSF) – 42 patients with symptomatic apical or anterior-apical genital prolapse, who underwent ligature SSF using the anterior approach LASSF (ligature anterior sacrospinous fixation); group 3 (MESH TASSF) – 79 patients with symptomatic apical or anterior-apical genital prolapse, who were treated by applying the anterior bilateral SSF method using synthetic tape MESH TASSF (tape anterior sacrospinous fixation). The frequency of intra- and postoperative complications, patient complaints, and relapse rates were assessed post-surgery. Functional outcomes were assessed using the PFDI-20 questionnaire (Pelvic Floor Distress Inventory-20) at 3, 6 and 12 months after treatment. Patients in group 3 were treated by applying a method we developed for correction of apical genital prolapse and concomitant cystocele reconstruction.Results. The method presented here was characterized by a lower blood volume loss compared to posterior SSF, minimized intra- and postoperative complications: decreased incidence of hematomas, buttock pain, rate of urinary disorders (stress incontinence, mixed forms of urinary incontinence, urgent urinary incontinence, urinary difficulty, bladder hypotension). Applying MESH TASSF fixation allowed to decrease duration of hospital treatment and alleviate pain severity in the postoperative period, and additionally contributed to improved patients' quality of life sustained for as long as 12 months post-surgery.Conclusion. The treatment results confirmed that the MESH bilateral SSF method using an anterior approach is clinically effective, relatively safe, and contributes to a markedly reduced rate of disease relapses. The presence of anterior-apical or apical genital prolapse (C or Ba+C prolapse, stages II–IV according to the POP-Q) should be considered as indications for performing anterior bilateral SSF.
Введение. Пролапс органов малого таза представляет собой одну из самых распространенных причин обращения пациенток к гинекологу. Предрасполагающими факторами развития опущения половых органов являются: эстрогенный дефицит, вагинальные роды, врожденная дисплазия соединительной ткани и прочее. Разработка специализированных подходов и методов лечения опущения половых органов является приоритетной задачей, которая стоит перед оперирующими хирургами. Цель исследования-оценка безопасности и эффективности использования различных методов хирургической коррекции пролапса тазовых органов у пациенток в зависимости от вида пролапса и клинических проявлений. Методы. Проведено обследование и оперативное лечение 188 женщин. В зависимости от вида пролапса пациентки разделены на три группы: 1-я-108 пациенток с выраженным дефектом лобково-шеечной фасции, которым установлены сетчатые импланты; 2-я-65 человек без выраженного анатомического дефекта лобково-шеечной связки, коррекция опущения проводилась урослингами и собственными тканями; 3-я-15 пациенткам с пролапсом гениталий, которые заинтересованы в сохранении репродуктивной функции, была выполнена сакровагинопексия. Результаты. Диагностировано 2 осложнения: в одном случае кровотечение объемом 1000 мл, что потребовало перевязки внутренних подвздошных артерий и гемотрансфузии; во втором случае-300 мл, произведено вскрытие и дренирование гематомы малого таза. Послеоперационный период в группах сравнения протекал без особенностей. Через 1 месяц у 2 пациенток обнаружена эрозия слизистой влагалища до 1 см. Анализ клинической картины в течение 1 года показал, что в группах сравнения отмечается улучшение функциональных исходов и анатомических результатов. Заключение. При наличии пролапса гениталий необходим индивидуальный подход к каждой женщине, что способствует комплаентности пациентки, а также уменьшению количества послеоперационных осложнений и рецидивов. Сетчатые импланты улучшают результаты хирургического лечения у пациенток с грубыми дефектами лобково-шеечной фасции, при наличии недержания мочи эффективными являются операции с использованием урослингов. Ключевые слова: пролапс органов малого таза, сетчатые импланты, стрессовое недержание мочи, сакропексия, лечение пролапса гениталий Конфликт интересов: авторы заявляют об отсутствии конфликта интересов.
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