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

Abstract

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.

Scoping review of cytolytic vaginosis literature

“…Four of the 32 non-review studies (13%) provided results of treatment: Cerikcioglu et al reported baking soda irrigation was effective in two women who used it [ 23 ]; Shopova et al stated that 32 out of 47 women improved after baking soda irrigation [ 59 ]; Hacisalihoglu et al reported that >95% of dyspareunia, discharge, and severe discomfort symptoms improved after a 10-day course of baking soda sitz baths [ 36 ]; and Lapina et al treated women post cystocele surgery with sertaconazol vaginal suppository and an alkaline (pH 8–9) vaginal moisturizer and found that women with CV had 100% resolution of their symptoms [ 43 ]. Only Lapina et al did further testing after symptomatic resolution, using pH, and found that pH normalized in women after the treatment [ 43 ].…”