Assessment of modern possibilities for correction of stress urinary incontinence and pelvic organ prolapse without the use of mesh implants

BACKGROUND: From 40 to 80% of women over 50 years of age suffer from pelvic organ prolapse (POP) with varying degrees of clinical manifestations. POP is often combined with stress urinary incontinence (SUI). With the growing trend of abandoning foreign meshes in pelvic surgery, the search for other treatment methods is a pressing issue.AIM: To assess the possibilities of correcting stress urinary incontinence and pelvic organ prolapse without the use of mesh implantsMethods: The prospective clinical study included 70 women with pelvic organ prolapse of varying degrees. Patients with stage 1 POP according to the POP-Q classification were included in the study only in case of concomitant complaints of SUI. They were allocated to a separate first group (n = 24). The second group included patients with stages 2-4 POP according to POP-Q with mandatory prolapse of the apical compartment (n = 46). The patients in each group were divided into two subgroups. In subgroup 1A, a transurethral injection of a volume-forming agent was performed, in subgroup 1B - the classic TVT-O installation. In the second group, two types of surgical intervention were performed in accordance with the subgroup belonging. In 2A - laparoscopic promontofixation of the cervical stump using mesh-less technology (native tissues and suture material), and in 2B - classic laparoscopic sacrovaginopexy using a polypropylene mesh implant.Results: n the first group, 12 months after the introduction of fillers, the clinical effect remained in 40% of patients, which is more than 2 times lower than in the group with the installation of a mesh sling (93%).  In the second group, it was shown that the anatomical success rate after 1 month was 92% in subgroup 2A (mesh-less) versus 90% in 2B (p = 0.265). Conclusion: With minor advantages of various mesh implants in pelvic surgery, their high cost and an increase in the number of intra- and postoperative complications entail a tendency to abandon them in favor of new modified surgical methods using native tissues and non-surgical injection techniques in the case of SUI.