Application of modern non-medicine technologies to improve the state of the mucous vagina in patients of different age groups after plastic surgery for the rectocele

Abstract

Background. The specific weight of genital prolapse among gynecological nosologies in Russia in the departments of operative gynecology ranges from 28 to 38.9% and in the structure of planned indications for surgical treatment ranks third after benign tumors and endometriosis.

Aim. Development and implementation of new comprehensive rehabilitation programs for women with II−III degree rectocele after surgical treatment.

Methods. The article presents the treatment data for 100 women of different age groups with II−III degree rectocele who, in the early postoperative period after plastic surgery for rectocell, used to improve the condition of the vaginal mucosa with general magnetotherapy, electromyostimulation with biological connection of the pelvic floor muscles, a special complex of physiotherapy exercises and intravaginal procedures of fractional microablative carbon dioxide laser therapy. The patients were divided into 2 groups comparable in terms of clinical and functional characteristics; within each group, depending on age, they were divided into

2 subgroups: women of childbearing age were included in subgroup A, and peri- and menopausal women were included in subgroup B. To assess the condition of the vaginal mucosa and maturity of the vaginal epithelium after surgery in patients included in the study, a pH-metry of the vaginal discharge was performed and the Vaginal Health Index was determined.

Results. As a result of the studies, it was found that a more pronounced therapeutic effect was obtained with the use of the complex, which includes a course of general magnetotherapy from the first day after surgery, as well as a month after surgery, a course of electromyostimulation with biological connection of the pelvic floor muscles and a special complex of physiotherapy exercises and 2 intravaginal procedures of fractional microablative carbon dioxide laser therapy.

Conclusion. The obtained results indicate a pronounced therapeutic effect of the complex, which includes a course of General magnetotherapy from the first day after surgery, a course of electromyostimulation with biological connection of pelvic floor muscles and a special complex of physical therapy, as well as 2 intravaginal procedures of fractionation microablative therapy with a carbon dioxide laser 1 month after surgery..

Keywords

pelvic organ prolapse / rectocele / childbearing / peri- and menopausal age / surgical intervention / vaginal mucosa / pH meter / vaginal health index / non-drug technologies / general magnetotherapy / electromyostimulation / biological feedback / fractional microablative therapy with a CO2 laser

References

[1] Abuladze TV, Shapataeva KV, Ivanishvili TK, et al. Operatsii pri kombinirovannom: vypadenii pryamoi kishki i matki, nedostatochnost' anal'nogo zhoma i rektotsele. In: Tezisy doklalov V Vserossiiskoi konferentsii s mezhdunarodnym uchastiem «Aktual'nye problemy koloproktologii». Rostov-on-Don; 2001. p. 4. (In Russ).

[2] Абуладзе Т.В., Шапатаева К.В., Иванишвили Т.К., и др. Операции при комбинированном: выпадении прямой кишки и матки, недостаточность анального жома и ректоцеле // Тезисы доклалов V Всероссийской конференции с международным участием «Актуальные проблемы колопроктологии». — Ростов-на-Дону; 2001. — С. 4.

[3] Hitar'jan AG, Prokudin SV, Dul'erov KA. Improved diagnostic and surgical treatment of patients with rectocele. Meditsinskii vestnik Yuga Rossii. 2016;(1):77-83. (In Russ).

[4] Хитарьян А.Г., Прокудин С.В., Дульеров К.А. Совершенствование диагностического обследования и хирургической тактики лечения больных ректоцеле // Медицинский вестник Юга России. — 2016. — Т.60. — №1 — С. 77-83.

[5] Bezhenar VF, Bogatyreva EV, Tsypurdeeva AA, et al. Complications from pelvic organ prolapse correction using a Prolift prolene system: ways of prevention and quality of life. Akusherstvo i ginekologiia. 2012;(4-2):116-121. (In Russ).

[6] Беженарь В.Ф., Богатырева Е.В., Цыпурдеева А.А., и др. Осложнения при коррекции тазового пролапса с использованием проленовой системы Prolift: пути профилактики и качество жизни // Акушерство и гинекология. — 2012.— №4-2 — С. 116-121.

[7] Ginekologiya. Natsional'noe rukovodstvo. Ed by Kulakov VI, Savel'eva GM, Manukhin IB. Moscow: GEOTAR-Media; 2009. (In Russ).

[8] Гинекология. Национальное руководство / Под ред. Кулакова В.И., Савельевой Г.М., Манухина И.Б. — М.: ГЕОТАР-Медиа; 2009.

[9] Podolsky VV, Podolsky VV. Modern possibilities of recovery and healing genital lower division women. Zdorovʹe zhenshchiny. 2014;(8):102-104. (In Russ).

[10] Подольский В.В., Подольский В.В. Современные возможности восстановления и заживления половых органов нижнего отдела у женщин // Здоровье женщины. — 2014. — №8 — С. 102-104.

[11] Altomare DF, Rinaldi M, Veglia A, et al. Combined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique. Dis Colon Rectum. 2002;45(11):1549-1552. Doi: 10.1007/s10350-004-6465-9.

[12] Altomare D.F., Rinaldi M., Veglia A., et al. Combined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique // Dis Colon Rectum. — 2002. — Т.45. — №11 — С. 1549-1552. Doi: 10.1007/s10350-004-6465-9.

[13] Apolikhina IA, Gorbunova EA. Clinical and morphological aspects of vulvovaginal atrophy. Meditsinskii sovet. 2014;(9):110-116.

[14] Аполихина И.А., Горбунова Е.А. Клинико-морфологические аспекты вульвовагинальной атрофии // Медицинский совет. — 2014. — №9 — С. 110-116.

[15] Groshilin VS, Shvetsov VK, Uzunyan LV. Preimushchestva ispol'zovaniya individual'nykh kriteriev vybora metoda lecheniya rektotsele. Koloproktologiya. 2016;(1S):23a.

[16] Грошилин В.С., Швецов В.К., Узунян Л.В. Преимущества использования индивидуальных критериев выбора метода лечения ректоцеле // Колопроктология. — 2016. — №1S — C. 23a.

[17] Zhukov BN, Isaev VR, Sukhobokov AA, Savinkov AI. Operativnoe lechenie poslerodovoi nedostatochnosti anal'nogo sfinktera. In: (Conference proceedigs) Aktual'nye voprosy koloproktologii. Materialy I s'ezda koloproktologov Rossii. Samara; 2003. p. 59-61; 118. (In Russ).

[18] Жуков Б.Н., Исаев В.Р., Сухобоков А.А., Савинков А.И. Оперативное лечение послеродовой недостаточности анального сфинктера // Актуальные вопросы колопроктологии. Материалы I съезда колопроктологов России. — Самара; 2003. — С. 59-61; 118.

[19] Smirnov AB, Khvorov VV. Sravnitel'naya otsenka metodov khirurgicheskoi korrektsii rektotsele. Khirurgiyia. 2006;(10):22-26. (In Russ).

[20] Смирнов А.Б., Хворов В.В. Сравнительная оценка методов хирургической коррекции ректоцеле // Хирургия. Журнал им. Н.И. Пирогова. — 2006. — №10 — С. 22-26.

[21] Balan VE, Kovaleva LA. Combination treatment of urogenital atrophy and recurrent urinary tract infections in postmenopausal women. Effektivnaya farmakoterapiya. 2013;(18):48-53. (In Russ).

[22] Балан В.Е., Ковалева Л.А. Комплексное лечение урогенитальной атрофии и рецидивирующих инфекций мочевых путей в постменопаузе // Эффективная фармакотерапия. — 2016. — №18 — С. 48-53.

[23] Glazunova AV, Yureneva SV, Ezhova LS. Vulvovaginal atrophy: symptoms, impact on emotional well-being, quality, and sexual function. Akusherstvo i ginekologiia. 2015;(12):97-102. (In Russ).

[24] Глазунова А.В., Юренева С.В., Ежова Л.С. Вульвовагинальная атрофия: симптомы, влияние на эмоциональное благополучие, качество жизни и сексуальную функцию // Акушерство и гинекология. — 2015. — №12 — С. 97-102.

[25] Dobrokhotova YuE, Ibragimova DM, Mandrykina ZhA, Serova LG. Mikrobiotsenoz genital'nogo trakta zhenshchin. Moscow: GEOTAR-Media; 2014. 80 p. (In Russ).

[26] Доброхотова Ю.Э., Ибрагимова Д.М., Мандрыкина Ж.А., Серова Л.Г. Микробиоценоз генитального тракта женщин. — М.: ГЭОТАР-Медиа. 2014. 80 c.

[27] Dobrokhotova YuE, Ilyina IYu, Venediktova MG, et al. Local nonhormonal therapy in patients with genitourinary menopausal syndrome. Rossiiskii vestnik akushera-ginekologa. 2018;18(3):88-94. (In Russ). Doi: 10.17116/rosakush201818288-94.

[28] Доброхотова Ю.Э., Ильина И.Ю., Венедиктова М.Г., и др. Локальная негормональная терапия больных с генитоуринарным менопаузальным синдромом // Российский вестник акушера-гинеколога. — 2018. — Т.18. — №3 — С. 88-94. Doi: 10.17116/rosakush201818288-94.

[29] Tikhomirov AL, Kazenashev VV, Yudina TA. Contemporary nonhormonal correction of the menopausal disturbances. Meditsinskii sovet. 2016;(12):102-105. (In Russ). Doi: 10.21518/2079-701X-2016-12-102-105.

[30] Тихомиров А.Л., Казенашев В.В., Юдина Т.А. Современная негормональная коррекция менопаузальных нарушений // Медицинский совет. — 2016. — №12 — С. 102-105. Doi: 10.21518/2079-701X-2016-12-102-105.

[31] Yureneva SV, Ermakova EI, Glazunova AV. Genitourinary syndrome of menopause in peri- and postmenopausal patients: Diagnosis and therapy (short clinical guideline). Akusherstvo i ginekologiia. 2016;(5):138-144. (In Russ). Doi: 10.18565/aig.2016.5.138-144.

[32] Юренева С.В., Ермакова Е.И., Глазунова А.В. Диагностика и терапия генитоуринарного менопаузального синдрома у пациенток в пери- и постменопаузе (краткие клинические рекомендации) // Акушерство и гинекология. — 2016. — №5 — С. 138-144. Doi: 10.18565/aig.2016.5.138-144.

[33] Erekson EA, Yip SO, Wedderburn TS, et al. The VSQ: a questionnaire to measure vulvovaginal symptoms in postmenopausal women. Menopause. 2013;20(9):973-979. Doi: 10.1097/GME.0b013e318282600b.

[34] Erekson E.A., Yip S.O., Wedderburn T.S., et al. The VSQ: a questionnaire to measure vulvovaginal symptoms in postmenopausal women // Menopause. — 2013. — Т.20. — №9 — С. 973-979. Doi: 10.1097/GME.0b013e318282600b.

[35] Rad'ko VYu. Sovremennye vozmozhnosti vosstanovleniya slizistoi obolochki vlagalishcha i ustranenie simptomov vaginal'nogo diskomforta pri lechenii nespetsificheskikh kol'pitov. Zhenskoe zdorov'e. 2016;(5):30-32. (In Russ).

[36] Радько В.Ю. Современные возможности восстановления слизистой оболочки влагалища и устранение симптомов вагинального дискомфорта при лечении неспецифических кольпитов // Женское здоровье. — 2016. — Т.60. — №5 — С. 30-32.

[37] Ettinger B, Hait H, Reape KZ, Shu H. Measuring symptom relief in studies of vaginal and vulvar atrophy: the most bothersome symptom approach. Menopause. 2008;15(5):885-889. Doi: 10.1097/gme.0b013e318182f84b.

[38] Ettinger B., Hait H., Reape K.Z., Shu H. Measuring symptom relief in studies of vaginal and vulvar atrophy: the most bothersome symptom approach // Menopause. — 2008. — Vol.15. — N5 — P. 885-889. Doi: 10.1097/gme.0b013e318182f84b.

[39] Sinha A, Ewies AA. Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric. 2013;16(3):305-312. Doi: 10.3109/13697137.2012.756466.

[40] Sinha A., Ewies A.A. Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview // Climacteric. — 2013. — Т.16. — №3 — С. 305-312. Doi: 10.3109/13697137.2012.756466.

[41] Berlin AL, Hussain M, Phelps R, Goldberg DJ. A prospective study of fractional scanned nonsequential cabon dioxide laser resurfacing: a clinical and histopathologic evaluation. Dermatol Surg. 2009;35(2):222-228. Doi: 10.1111/j.1524-4725.2008.34413.x.

[42] Berlin A.L., Hussain M., Phelps R., Goldberg D.J. A prospective study of fractional scanned nonsequential cabon dioxide laser resurfacing: a clinical and histopathologic evaluation. Dermatol Surg. 2009;35(2):222–228. Doi: 10.1111/j.1524-4725.2008.34413.x.

RIGHTS & PERMISSIONS

Eco-Vector