Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE

BACKGROUND: The incidence of prolapse after hysterectomy requiring surgical intervention is estimated at 36 cases per 10,000 women. A universal surgical treatment method for post-hysterectomy pelvic organ prolapse is lacking, prompting the need for new approaches. AIM: To comparatively analyze the results of laparoscopic sacrocolpopexy, sacrospinous fixation, and the developed new method of surgical correction of pelvic organ prolapse after hysterectomy. MATERIAL AND METHODS: This prospective non-randomized study included 57 patients with stage II, III, or IV symptomatic post-hysterectomy prolapse of the pelvic organs who were admitted at the clinical hospital RZD-Medicine in Tula, Russia, between August 2019 and September 2023. The first group (n=18) consisted of women who underwent surgical correction of post-hysterectomy pelvic organ prolapse in a newly developed method; the second group (n=19) included women who underwent laparoscopic promontofixation according to the conventional technique; and the third group (n=20) involved patients who underwent installation of an apical sling using a UroSling-1 mesh endoprosthesis (Lintex LLC, St. Petersburg). The patients’ quality of life was assessed using specialized validated questionnaires: Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Patients were asked to complete questionnaires before surgery and 12 and 24 months after surgical correction of PGP. The patients were invited for a follow-up examination after 1, 6, 12, and 24 months. RESULTS: The duration of the operation in the second group significantly exceeded the indicators of the first and third groups. The average duration of hospital stay of patients was 4.4±0.6 (95% CI: 4.1–4.7) bed days in the first group, 4.9±1.1 (95% CI: 4.6–5.3) in the second, and 4.6±0.6 (95% CI: 4.3–4.9) in the third. The differences were insignificant (p1–2=0.437; p1–3=0.137; p2–3=0.235). The anatomical results after 24 months at points Aa and Ba showed significant differences. At point Aa, p1–3=0.007 and p2–3=0.004, and at point Ba, p1–3=0.032 and p2–3=0.041. A comparative assessment of the questionnaire data before surgery and 12 and 24 months after surgery showed a significant improvement in the quality of life of patients in the three groups. CONCLUSION: The proposed method of correction of post-hysterectomy pelvic organ prolapse provides high anatomical and functional results and reduces the posibility of repeated surgical intervention for recurrence.

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Analysis of risk factors for pelvic organ prolapse in females after hysterectomy

Soloveva

Волков²

2022

Gynecology

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Aim. To identify risk factors for pelvic organ prolapse in females after hysterectomy. Materials and methods. A cross-sectional study from August 2019 to October 2021 in women after hysterectomy for benign neoplasms (n=91) analyzed history, outpatient medical record data, and clinical examination findings. Pelvic organ prolapse was assessed using the POP-Q (Pelvic Organ Prolapse Quantification) international classification. All patients were divided into two groups: Group 1 (n=61) included patients with the pelvic organ prolapse; Group 2 (n=30) included patients without the pelvic organ prolapse. Results. Post-hysterectomy pelvic organ prolapse was observed in 67% (61/91) patients, including grade 1 in 49.2% (30/61), grade 2 in 36.0% (22/61), and grade 3 in 14.8% (9/61). The significant risk factors include obstetric trauma (41 83.7%; odds ratio OR 5.6, 95% confidence interval CI 2.114.8; p=0.00034), age (49 84.5%; OR 19.7, 95% CI 0.5990.831; p=0.00001) and lifestyle associated with weight lifting (32 72.1%; OR 9.8, 95% CI 0.63.9; p=0,00267). No statistically significant differences were observed when comparing the prolapse rate with the presence of connective tissue dysplasia and somatic disorders. Analysis of cumulative risk factors showed significant differences; in Group 1, the mean number of risk factors was 4.61.6 (95% CI 3.26.1), and in Group 2, 2.71.8 (95% CI 2.53.8), t-test value was 6.76, p0.001. Conclusion. Genital prolapse occurs in more than 1/2 of females after hysterectomy. The most significant risk factors are obstetric trauma, age, and a lifestyle associated with weight lifting. The incidence of pelvic organ prolapse increases when several risk factors are combined.

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Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE

Cited by 3 publications

References 19 publications

Comparative characteristics of laparoscopic sacrovaginopexy and transvaginal sacrospinous fixation

Comparative characteristics of laparoscopic sacrovaginopexy and transvaginal sacrospinous fixation

Comparative analysis of methods of surgical correction of post-hysterectomy pelvic organ prolapse

Analysis of risk factors for pelvic organ prolapse in females after hysterectomy

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