Dmitry Shkarupa*, Nikita Kubin, Ekaterina Shapovalova, Olga Staroseltseva, Anastasia Zaytseva
INTRODUCTION AND OBJECTIVES: The majority of patients with expressed anterior vaginal wall prolapse have associated defect in apical compartment, that predisposes simultaneous correction of the defects. A leading role of the apical support in the pathogenesis of pelvic organ prolapse point at the need of its durable restoration. Whereas a high rate of mesh-associated complications dictates the reducing of synthetic materials in pelvic reconstructive surgery. The objective of this study was to evaluate a mid-term effectiveness of the hybrid technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling1, Lintex) in combination with the original technique of subfascial colporrhaphy (Holsted suture laid on the internal surface of vaginal fascia) in surgical treatment of POP with associated defects of the apical support and pubocervical fascia.
METHODS: This prospective study involved 148 women suffering from a combination of the apical prolapse with a prolapse of the anterior vaginal wall. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound were used, determined before the surgery and at control examinations (1,6, 12, 24 months). Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires.
RESULTS: Of the 148 women operated, 126 remained at 24- months. Mean operation time was 32 11 minutes. There were no cases of intraoperative damage of the bladder or rectum, as well as clinically significant bleeding. The recurrence rate was 2.2% at 12 months (cystocele II-III stage in 3 patients), at 24 months two more cases were identified: 1-cystocele (II stage), 1-apical prolapse (II stage). The effectiveness of the surgery was 96.0% at 24 months. There were no statistically significant changes of Qmax or PVR in comparison to 12- month data. After 6 months of follow-up stress urinary incontinence de novo was noted in 4.7%, to a two-year follow-up, this number didn0 t increase. There were no cases of mesh erosions during 24 months of follow-up. Most of the patients reported a significant improvement in the quality of life after treatment.
CONCLUSIONS: The hybrid technique showed high mid-term results in treating patients with a combination of the apical prolapse with a prolapse of the anterior vaginal wall. It provides high functional results and improves quality of life.
