Long-term outcomes of surgical interventions for different types of pelvic organ prolapse
- Authors: Ishchenko A.I.1, Asambaeva A.1, Ishchenko A.A.2, Khokhlova I.D.1, Dzhibladze T.A.1, Malyuta E.G.2, Aleksandrov L.S.1, Gorbenko O.Y.1, Tevlina E.V.1, Ageev M.B.1, Baburin D.V.1, Moskvicheva A.P.1, Khalyavka E.D.1, Ivanova V.V.1
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Affiliations:
- I.M. Sechenov First Moscow State Medical University
- National Medical Research Center «Treatment and Rehabilitation Center»
- Issue: Vol 10, No 4 (2023)
- Pages: 287-297
- Section: Original study articles
- URL: https://archivog.com/2313-8726/article/view/624649
- DOI: https://doi.org/10.17816/2313-8726-2023-10-4-287-297
- ID: 624649
Cite item
Abstract
Background. The study aimed to comparatively analyze the nature and frequency of complications and the severity of recurrences among patients with different forms of pelvic organ prolapse (POP). These factors will be examined depending on the surgical technique employed.
Materials and methods. The study involved a thorough clinical evaluation, surgical intervention, and outpatient monitoring (at 1, 6, 12, 24, and 36 months) of 523 participants, aged 32–80 years, categorized into four main groups and 3–4 subgroups depending on the type of POP and surgical method used. Group 1 comprised 161 women (30.8%) presenting with grade I–III cervical elongation combined with grade I–II anterior vaginal wall prolapse. Group 2 consisted of 207 (39.6%) patients with grade II–III anterior vaginal wall prolapse, whereas group 3 included 107 patients (20.5%) with complete uterine prolapse. Group 4 was made up of 48 women (9.1%) with grade II–III posterior vaginal wall descent.
Results. Based on the acquired data, synthetic implant extrusion commonly took place 6–12 months after the surgical procedure. Of the 158 patients who received polypropylene endoprostheses, 20 (12.7%) experienced extrusion and required repeated hospitalizations for partial or complete excision, followed by restoration of vaginal wall integrity. POP recurrences typically occurred 12–36 months after surgical treatment and were detected in 69 (13.2%) of 523 patients. The reappearance of symptoms of pelvic organ descent was most commonly identified in patients who underwent surgery using their tissues (26.6%), less frequently with synthetic implants (12.7%), and extremely rarely with titanium endoprostheses (1.6%).
Conclusions. The results revealed that patients, who underwent surgery using original techniques, employing titanium-made mesh implants and anchors, experienced the fewest complications and postoperative POP incidence. Conversely, the use of synthetic implants increases the likelihood of mesh-associated complications and disease recurrence, necessitating partial or complete excision. The use of autologous tissue for POP surgery is related to a higher likelihood of recurring prolapse symptoms.
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About the authors
Anatolii I. Ishchenko
I.M. Sechenov First Moscow State Medical University
Author for correspondence.
Email: 7205502@mail.ru
ORCID iD: 0000-0003-3338-1113
MD, Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology No. 1
Russian Federation, MoscowAilar Asambaeva
I.M. Sechenov First Moscow State Medical University
Email: dr.ailar7@gmail.com
ORCID iD: 0000-0001-5399-7586
Graduate Student
Russian Federation, MoscowAnton A. Ishchenko
National Medical Research Center «Treatment and Rehabilitation Center»
Email: ra2001_2001@mail.ru
ORCID iD: 0000-0001-6673-3934
MD, Cand. Sci. (Med.)
Russian Federation, MoscowIrina D. Khokhlova
I.M. Sechenov First Moscow State Medical University
Email: irhohlova5@gmail.com
ORCID iD: 0000-0001-8547-6750
MD, Cand. Sci. (Med.)
Russian Federation, MoscowTea A. Dzhibladze
I.M. Sechenov First Moscow State Medical University
Email: djiba@bk.ru
ORCID iD: 0000-0003-1540-5628
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowElena G. Malyuta
National Medical Research Center «Treatment and Rehabilitation Center»
Email: egma@list.ru
ORCID iD: 0000-0003-0098-0830
MD, Cand. Sci. (Med.)
Russian Federation, MoscowLeonid S. Aleksandrov
I.M. Sechenov First Moscow State Medical University
Email: aleksandrov.leonid@lenta.ru
ORCID iD: 0000-0002-7601-3532
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowOksana Yu. Gorbenko
I.M. Sechenov First Moscow State Medical University
Email: go2601@mail.ru
ORCID iD: 0000-0002-3435-4590
MD, Cand. Sci. (Med.)
Russian Federation, MoscowEkaterina V. Tevlina
I.M. Sechenov First Moscow State Medical University
Email: tevlina.ekaterina@gmail.com
ORCID iD: 0009-0003-5235-1814
Assistant Lecturer
Russian Federation, MoscowMikhail B. Ageev
I.M. Sechenov First Moscow State Medical University
Email: mikhaageev@ya.ru
ORCID iD: 0000-0002-6603-804X
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowDmitrii V. Baburin
I.M. Sechenov First Moscow State Medical University
Email: baburin_d_v@staff.sechenov.ru
ORCID iD: 0000-0003-2398-3348
MD, Cand. Sci. (Med.)
Russian Federation, MoscowAnastasiya P. Moskvicheva
I.M. Sechenov First Moscow State Medical University
Email: 09-19@rambler.ru
ORCID iD: 0000-0003-1763-4205
Graduate Student
Russian Federation, MoscowElena D. Khalyavka
I.M. Sechenov First Moscow State Medical University
Email: elhalyavka@gmail.com
ORCID iD: 0009-0003-4894-6655
Clinical Resident
Russian Federation, MoscowViktoriya V. Ivanova
I.M. Sechenov First Moscow State Medical University
Email: obstetrics-gynecology@list.ru
ORCID iD: 0000-0002-0917-7713
Obstetrician-Gynecologist
Russian Federation, MoscowReferences
- Buianova SN, Shchukina NA, Zubova ES, Sibryaeva VA, Rizhinashvili ID. Genital prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2017;17(1):3745. (In Russ). doi: 10.17116/rosakush201717137-45
- Gvozdev MYu, Tupikina NV, Kasyan GR, Pushkar’ DYu. Pelvic organ prolapse in the clinical practice of a urologist. Methodological recommendations No. 3. Moscow: ABV-press; 2016. (In Russ).
- Russian Society of Obstetricians and Gynecologists, All-Russian public organization “Russian Society of Urologists”. Prolapse of female genitalia. Clinical recommendations. Moscow: Ministry of Health of the Russian Federation; 2021. Available from: http://zdrav.spb.ru/media/filebrowser/выпадение_женских_половых_органов.pdf (In Russ).
- Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J. 2013;24(11):1803–1813. doi: 10.1007/s00192-013-2171-2
- Jelovsek JE. Pelvic organ prolapse in women: Choosing a primary surgical procedure [Internet]. UpToDate, 2017. [cited 2023 Oct 7]. Available from: https://www.uptodate.com/contents/pelvic-organ-prolapse-in-women-choosing-a-primary-surgical-procedure
- Strizhakov AN, Davydov AI, Belotserkovtseva LD. Pelvic organ prolapse. Return to the sources: the FDA reclassifies the use of MESH technologies. Gynecology, Obstetrics and Perinatology. 2017;16(3):47–50. (In Russ). doi: 10.20953/1726-1678-2017-3-47-50
- De Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J. 2013;24(11):1859–1872. doi: 10.1007/s00192-013-2177-9
- Manodoro S, Reato C, Cola A, Palmieri S, Frigerio M. Prolapse mesh complication: large stone on vaginal mesh extruded in the bladder. Eur J Obstet Gynecol Reprod Biol. 2019;235:131–132. doi: 10.1016/j. ejogrb.2019.02.012
- Ishchenko AI, Ivanova VV, Ishchenko AA, et al. A new method of organ-preserving surgical correction of cervical elongation using titanium mesh implants. The “Moscow” surgery. Gynecology, Obstetrics and Perinatology. 2021;20(4):84–92. (In Russ). doi: 10.20953/1726-1678-2021-4-84-92
- Patent RUS №203395 U1/ 02.04.21. Byul. №10. Ishchenko AI, Gorbenko OYu, Ishchenko AA, et al. Fiksator ligatury v myagkikh tkanyakh. Available from: https://patents.s3.yandex.net/RU203395U1_20210402.pdf (In Russ).
- Patent RUS № 2755668 C1/ 20.09.21. Byul. №26. Ishchenko A.I., Ishchenko A.A., Ivanova VV, et al. Sposob khirurgicheskogo lecheniya prolapsa tazovykh organov v sochetanii s elongatsiei sheiki matki (Moskovskaya operatsiya). Available from: https://patents.s3.yandex.net/RU2755668C1_20210920.pdf (In Russ).
- Ishchenko AI, Aleksandrov LS, Ishchenko AA, et al. Anterior colporaphy using mesh titanium implants. First experience. Gynecology, Obstetrics and Perinatology. 2019;18(2):5–12. (In Russ). doi: 10.20953/1726-1678-2019-2-5-12
- Ishchenko AA, Ishchenko AI, Aleksandrov LS, et al. Transvaginal surgical prevention of posthysterectomy prolapse of the vaginal dome in patients with complete uterine prolapsed. Gynecology, Obstetrics and Perinatology. 2017;16(3):43–46. doi: 10.20953/1726-1678-2017-3-43-46
- Ishchenko AI, Aleksandrov LS, Ishchenko AA, et al. Mesh-ligature correction of posterior vaginal wall prolapse grade II–III using titanium mesh implants. Gynecology, Obstetrics and Perinatology. 2020;19(3):14–21. (In Russ). doi: 10.20953/1726-1678-2020-3-14-21
- Korshunov MYu, Sazykina EI. PD-QL questionnaire ― validated instrument for symptoms and quality of life assessment in patients with pelvic organ prolapse. Journal of Obstetrics and Womans Diseases. 2008;3:86–93. (In Russ).
- Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) ― a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75–81.