Rola defektu apikalnego w patogenezie obniżenia narządów miednicy mniejszej: cystocele z defektem apikalnym

Abstract

Introduction: In urogynecology, both in subject literature and in clinical work, different systems for the assessment of pelvic organ prolapse are used. The lack of standardization causes diffi culties in treatment planning and in the evaluation of the effectiveness of applied surgical methods. The most commonly used scale is the POP-Q System which describes the severity of the prolapse without taking the type of defect into account. On the other hand, the clinical classifi cation by DeLancey defi nes the type of defect but does not take its severity into account. The latter classifi cation system also does not include cystocele with apical defect. Material and methods: The authors examined 96 patients presenting for advice of treatment due to symptomatic pelvic fl oor disease. A new, standardized method of urogycological examination was implemented. The evaluation included the type of defect and its severity at all three pelvic fl oor levels. Results: This method of examination allowed the identifi cation of both already known cystocele with middle and lateral defects, as well as not yet described cystocele with apical and mixed defects. Conclusions: The authors propose a new, standardized method of urogynecological examination which assumes the simultaneous application of the POP-Q System and the modifi ed classifi cation of lower pelvic organ prolapse by DeLancey which also describes the impact of level I defects (apical defects) on level II prolapse. It seems that this approach allows for more effective planning of urogynecological procedures, while reducing the rate of recurrence.

Women’s problems associated with pelvic floor muscle dysfunction

“…Strong pelvic floor muscles in women, especially the ischiofemoral muscle that attaches to the clitoral hood, are crucial for adequate genital stimulation and orgasm, while weak or lacking muscles may cause insufficient activity necessary for vaginal congestion and inhibit orgasmic potential. During sexual activity, sexual pleasure for both partners is enhanced by genital responses provided by contraction of the anal lever.Sexual health, which includes sexual satisfaction and function, can be compromised by pelvic floor disorders such as: pain syndromes, pelvic organ lowing, incontinence [7,11,12,13].…”

“…The literature on the subject suggests that the tone of the pelvic floor muscles, their strength and ability to contract are important factors in vaginal flexibility, responsiveness, pleasure during intercourse for both partners and orgasmic muscle response. Some studies have shown that strong pelvic floor muscles may be associated with better orgasmic potential and arousal, desire, and vaginal lubrication, as well as increased vaginal sensation and tension [11,13,14,15,16].…”

“…Zdrowie seksualne, które obejmuje satysfakcję i funkcje seksualne, może ulec pogorszeniu przez zaburzenia dna miednicy, takie jak: zespoły bólowe, obniżanie narządów miednicy, nietrzymanie moczu [7,11,12,13].…”

“…Literatura przedmiotu podaje, iż napięcie mięśni dna miednicy, ich siła i zdolność do kurczenia się, są istotnymi czynnikami wpływającymi na elastyczność pochwy, reaktywność, przyjemność podczas stosunku dla obojga partnerów oraz orgazmiczną reakcję mięśniową. Niektóre badania wykazały, że silne mięśnie dna miednicy mogą być związane z lepszym potencjałem orgazmu i pobudzenia, pożądaniem, podnieceniem i nawilżeniem pochwy, a także zwiększonym czuciem i napięciem pochwy [11,13,14,15,16]. Hipotonia dna miednicy może zaś wpływać negatywnie na funkcje seksualne, gdyż brak kontroli zwieracza prowadzi do objawów podczas stosunku płciowego, takich jak wzdęcia i nietrzymanie moczu lub jelit.…”

A Randomized Clinical Trial Comparing Dubuisson Laparoscopic Lateral Suspension with Laparoscopic Sacropexy for Pelvic Organ Prolapse: Short-Term Results

“…Apical defect rates range between 5 and 15%, and many procedures and materials have been proposed to improve the outcomes for the treatment of this compartment [ 6 , 7 , 8 , 9 , 10 , 11 ]. Laparoscopic sacrocolpopexy (LSC) is currently considered the gold standard surgery for apical prolapse [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. However, few randomized clinical trials compare sacropexy with other surgical techniques used in the treatment of apical defects [ 22 , 23 , 24 , 25 , 26 ].…”