Андрология и генитальная хирургия. 2020; 21: 44-50
Трансвагинальная mesh-хирургия переднеапикального пролапса тазовых органов у женщин
https://doi.org/10.17650/2070-9781-2020-21-2-44-50Аннотация
Цель исследования – оценить эффективность и безопасность 6-рукавного сетчатого имплантата OPUR при лечении переднеапикального пролапса.
Материалы и методы. Прооперированы 300 пациенток с переднеапикальным пролапсом (цистоцеле III–IV степени, гистероптозом II–IV степени). Коррекция пролапса выполнена с помощью 6-рукавного сетчатого имплантата OPUR.
Результаты. У 290 пациенток достигнут желаемый результат (полное устранение пролапса или пролапс I степени тяжести по классификации POP-Q (Pelvic Organ Prolapse Quantification System)). Но в 6 случаях развился рецидив гистероптоза, в 4 – рецидив цистоцеле. Выявлены следующие послеоперационные осложнения: гематома передней стенки влагалища, резорбция которой произошла самопроизвольно, – у 12 пациенток; острая задержка мочеиспускания, разрешившаяся в течение 3–7 дней после операции, – в 5,8 % случаев, эрозии слизистой оболочки влагалища – в 4 случаях (в 2 потребовалось иссечение фрагмента), интраоперационное повреждение мочевого пузыря – у 3 пациенток (из них у 2 коррекция пролапса после ушивания дефекта была завершена трансвагинальной контралатеральной сакроспинальной гистеропексией, дополненной передней кольпорафией; у 1 ушит дефект мочевого пузыря перед имплантацией).
Заключение. Трансвагинальная коррекция переднеапикального пролапса тазовых органов у женщин с помощью 6-рукавного имплантата эффективна и относительно безопасна. Получены хорошие анатомические результаты, сохраняющиеся длительное время после установки имплантата (не менее 4–5 лет).
Список литературы
1. Petros P. The female pelvic floor. Function, dysfunction and management according to the integral theory. Berlin, Heidelberg: Springer-Verlag, 2004. 222 p. DOI: 10.1007/978-3-662-05445-1.
2. Kenton K., Mueller E.R. The global burden of female pelvic floor disorders. BJU Int 2006;98 Suppl 1:1–5. DOI: 10.1111/j.1464-410X.2006.06299.x.
3. Gunasekera P., Sazaki J., Walker G. Pelvic organ prolapse: don’t forget developing countries. Lancet 2007;369(9575):1789–90. DOI: 10.1016/S0140-6736(07)60814-9.
4. Гинекология. Национальное руководство. Под ред. В.И. Кулакова, И.Б. Манухина, Г.М. Савельевой. М.: ГЭОТАР-Медиа, 2011. 1088 с.
5. Shah A.D., Kohli N., Rajan S.S., Hoyte L. The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J Pelvic Floor Dysfunct 2008;19(3):421–8. DOI: 10.1007/s00192-007-0457-y.
6. Barber M.D., Walters M.D., Bump R.C. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 2005;193(1):103–13. DOI: 10.1016/j.ajog.2004.12.025.
7. Guyomard A., Delorme E. Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh. Int J Gynaecol Obstet 2016;133(3):365–9. DOI: 10.1016/j.ijgo.2015.10.016.
8. Kasyan G., Tupikina N., Pushkar D. Types of pelviс floor defects in women with pelvic organ prolapse. J Urol 2017;197(4 Suppl):e51.
9. Flam F. Sedation and local anaesthesia for vaginal pelvic floor repair of genital prolapse using mesh. Int Urogynecol J Pelvic Floor Dysfunct 2007;18(12):1471–5. DOI: 10.1007/s00192-007-0350-8.
10. Fatton B., Amblard J., Debodinance P. et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (prolift technique) – a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct 2007;18(7):743–52. DOI: 10.1007/s00192-006-0234-3.
11. Bai S.W., Jeon M.J., Kim J.Y. et al. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2002;13(4):256–60. DOI: 10.1007/s001920200053.
12. Fatton B. Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? An overview. Int Urogynecol J Pelvic Floor Dysfunct 2009;20(2):235–45. DOI: 10.1007/s00192-008-0734-4.
13. Davila G.W., Jijon A. Managing vaginal mesh exposure/erosions. Curr Opin Obstet Gynecol 2012;24(5):343–8. DOI: 10.1097/GCO.0b013e328357a1c5.
14. Achtari C., Hiscock R., O’Reilly B.A. et al. Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J Pelvic Floor Dysfunct 2005;16(5):389–94. DOI: 10.1007/s00192-004-1272-3.
15. Gutman R.E., Nosti P.A., Sokol A.I. et al. Three-year outcomes of vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 2013;122(4):770–7. DOI: 10.1097/AOG.0b013e3182a49dac.
16. Khandwala S., Jayachandran C. Transvaginal mesh surgery for pelvic organ prolapse – Prolift+M: a prospective clinical trial. Int Urogynecol J 2011;22(11):1405–11. DOI: 10.1007/s00192-011-1482-4.
17. Dwyer P.L., O’Reilly B.A. Transvaginal repair of anterior and posterior compartment prolapse with atrium polypropylene mesh. BJOG 2004;111(8):831–6. DOI: 10.1111/j.1471-0528.2004.00194.x.
18. Helström L., Nilsson B. Impact of vaginal surgery on sexuality and quality of life in women with urinary incontinence or genital descensus.Acta Obstet Gynecol Scand 2005;84(1):79–84. DOI: 10.1111/j.0001-6349.2005.00668.x.
19. Weber A.M., Walters M.D., Pied monte M.R. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2000;182(6):1610–5. DOI: 10.1067/mob.2000.107436.
20. Handa V.L., Zyczynski H.M., Brubaker L. et al. Sexual function before and after sacrocolpopexy for pelvic organ prolapse. Am J Obstet Gynecol2007;197(6):629.e1-6. DOI: 10.1016/j.ajog.2007.08.016.
Andrology and Genital Surgery. 2020; 21: 44-50
Transvaginal mesh surgery for anterior apical prolapse of the pelvic organs in women
https://doi.org/10.17650/2070-9781-2020-21-2-44-50Abstract
The study objective is to evaluate the effectiveness and safety of the 6-arm mesh OPUR implant in treatment of anterior apical prolapse. Materials and methods. Three hundred patients with anterior apical prolapse (grade III–IV cystocele, grade II–IV hysteroptosis) underwent surgery. Prolapse repair was performed using the 6-arm mesh OPUR implant.
Results. In 290 patients, the intended result was achieved (full prolapse elimination or stage I prolapse per the POP-Q (Pelvic Organ Prolapse Quantification System)). However, in 6 cases recurrences of hysteroptosis, in 4 cases recurrences of cystocele were diagnosed. The following postoperative complications were observed: hematoma of the anterior vaginal wall with spontaneous resorption in 12 patients; acute urinary retention resolved in 3–7 days after the surgery in 5.8 % cases; vaginal mucosa erosion in 4 cases (in 2 cases, fragment resection was necessary); intraoperative injury of the bladder in 3 patients (in 2 cases, prolapse repair after defect suturing was finished with transvaginal contralateral sacrospinous hysteropexy supplemented by anterior colporrhaphy; in 1 case, bladder defect was sutured prior to implantation).
Conclusion. Transvaginal repair of anterior apical prolapse of the pelvic organs in women using the 6-arm implant is effective and relatively safe. Satisfactory anatomical results persisting for a long time (4–5 years) after implantation were achieved.
References
1. Petros P. The female pelvic floor. Function, dysfunction and management according to the integral theory. Berlin, Heidelberg: Springer-Verlag, 2004. 222 p. DOI: 10.1007/978-3-662-05445-1.
2. Kenton K., Mueller E.R. The global burden of female pelvic floor disorders. BJU Int 2006;98 Suppl 1:1–5. DOI: 10.1111/j.1464-410X.2006.06299.x.
3. Gunasekera P., Sazaki J., Walker G. Pelvic organ prolapse: don’t forget developing countries. Lancet 2007;369(9575):1789–90. DOI: 10.1016/S0140-6736(07)60814-9.
4. Ginekologiya. Natsional'noe rukovodstvo. Pod red. V.I. Kulakova, I.B. Manukhina, G.M. Savel'evoi. M.: GEOTAR-Media, 2011. 1088 s.
5. Shah A.D., Kohli N., Rajan S.S., Hoyte L. The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J Pelvic Floor Dysfunct 2008;19(3):421–8. DOI: 10.1007/s00192-007-0457-y.
6. Barber M.D., Walters M.D., Bump R.C. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 2005;193(1):103–13. DOI: 10.1016/j.ajog.2004.12.025.
7. Guyomard A., Delorme E. Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh. Int J Gynaecol Obstet 2016;133(3):365–9. DOI: 10.1016/j.ijgo.2015.10.016.
8. Kasyan G., Tupikina N., Pushkar D. Types of pelvis floor defects in women with pelvic organ prolapse. J Urol 2017;197(4 Suppl):e51.
9. Flam F. Sedation and local anaesthesia for vaginal pelvic floor repair of genital prolapse using mesh. Int Urogynecol J Pelvic Floor Dysfunct 2007;18(12):1471–5. DOI: 10.1007/s00192-007-0350-8.
10. Fatton B., Amblard J., Debodinance P. et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (prolift technique) – a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct 2007;18(7):743–52. DOI: 10.1007/s00192-006-0234-3.
11. Bai S.W., Jeon M.J., Kim J.Y. et al. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2002;13(4):256–60. DOI: 10.1007/s001920200053.
12. Fatton B. Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? An overview. Int Urogynecol J Pelvic Floor Dysfunct 2009;20(2):235–45. DOI: 10.1007/s00192-008-0734-4.
13. Davila G.W., Jijon A. Managing vaginal mesh exposure/erosions. Curr Opin Obstet Gynecol 2012;24(5):343–8. DOI: 10.1097/GCO.0b013e328357a1c5.
14. Achtari C., Hiscock R., O’Reilly B.A. et al. Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J Pelvic Floor Dysfunct 2005;16(5):389–94. DOI: 10.1007/s00192-004-1272-3.
15. Gutman R.E., Nosti P.A., Sokol A.I. et al. Three-year outcomes of vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 2013;122(4):770–7. DOI: 10.1097/AOG.0b013e3182a49dac.
16. Khandwala S., Jayachandran C. Transvaginal mesh surgery for pelvic organ prolapse – Prolift+M: a prospective clinical trial. Int Urogynecol J 2011;22(11):1405–11. DOI: 10.1007/s00192-011-1482-4.
17. Dwyer P.L., O’Reilly B.A. Transvaginal repair of anterior and posterior compartment prolapse with atrium polypropylene mesh. BJOG 2004;111(8):831–6. DOI: 10.1111/j.1471-0528.2004.00194.x.
18. Helström L., Nilsson B. Impact of vaginal surgery on sexuality and quality of life in women with urinary incontinence or genital descensus.Acta Obstet Gynecol Scand 2005;84(1):79–84. DOI: 10.1111/j.0001-6349.2005.00668.x.
19. Weber A.M., Walters M.D., Pied monte M.R. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2000;182(6):1610–5. DOI: 10.1067/mob.2000.107436.
20. Handa V.L., Zyczynski H.M., Brubaker L. et al. Sexual function before and after sacrocolpopexy for pelvic organ prolapse. Am J Obstet Gynecol2007;197(6):629.e1-6. DOI: 10.1016/j.ajog.2007.08.016.
