Category: Female Urology
Introduction & Objective : Introduction: pelvic organ prolapse is a state characterized by pelvic organ descent due to defect of the ligamentous apparatus. As a result, the quality of life of millions of women is deteriorated and the cost of health care is significant.
Objective: to assess the outcomes of surgical repair of anterior apical prolapse using the 6-strap sling mesh implant
Methods: the prospective study included 100 patients with genitourinary prolapse. The follow-up time was 12 to 72 months. The anatomical outcomes according to the POP-Q system and intra- and postoperative complications were assessed. Stage II and higher prolapse was considered to be a recurrence. The quality of life and sexual function were assessed using PFDI-20, PFIQ-7, and PSIQ-12.
The age of the patients varied between 34 and 76 years. All patients had stage III cystocele. The anterior vaginal wall descent in all the patients was associated with uterine descent (in 37 (37%), stage II; in 63 (63%), stage III). Twenty-one patients (21%) underwent colpoperineorrhaphy with levator repair using the standard method for stage II and stage III rectocele. Urinary incontinence occurred de novo in eight (8%) patients. No postoperative dyspareunia was revealed. The quality of life improved in 93 (93%) women as judged by the PFDI-20 data; in 87 (87%) women, according to the PFIQ-7 data. Nevertheless, women reported decreased emotional tension during sexual intercourse. The desirable anatomical result (≤ stage I according to the POP-Q system) was achieved in 97 (97%) patients. One patient had intraoperative hemorrhage due to gluteal vessel injury caused by the imperfect technique of passing transsacrospinal stylet. The following postoperative complications were observed: five anterior vaginal wall hematomas, which resorbed over six to nine weeks; one 250-mL paravesicular fat hematoma whose resorption time was four months; nine patients with dynamic ischuria resolved in the period of 3–7 postoperative days.
Genitourinary prolapse repair using 6-strap sling mesh is efficacious and relatively safe. The method demonstrates good anatomical results in relation to both anterior and apical prolapses. This technique does not envisage posterior vaginal wall repair. In the case of significant rectocele (> stage II), colpoperineorrhaphy with levator repair is possible. According to the outcomes of the four-year follow-up, the procedure of placement of a light-weight six-strap sling mesh using a transvaginal approach is possible and efficacious in the treatment of anterior apical genitourinary prolapse.
Petr Glybochko– Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Mikhail Enikeev– Head of Department, Sechenov University, Moscow, Moskva, Russia
Olesya Snurnitsyna– Moscow, Moskva, Russia
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia