Advantages of the modified colpocleisis operation in patients with atypical types of pelvic organ prolapse

Abstract

Background: Currently, there is no general universal unified surgical treatment strategy for patients with pelvic organ prolapse. Considering the risks of installing mesh implants and the increasing incidence of implant-associated complications, mesh-free pelvic floor surgery techniques have become relevant again. A method was developed and introduced into clinical practice, which is an electrosurgical vaginal hysterectomy followed by vaginal suturing using a modified colpocleesis operation, which allows combining all the advantages of this method and at the same time minimizing the risks of cancer in the future.

Aim: The aim of this study was to improve the results of surgical treatment in patients with rare, complicated and recurrent forms of pelvic organ prolapse.

Materials and methods: This study included 140 patients diagnosed with pelvic organ prolapse. The main group consisted of 70 individuals with rare, severe and complicated cases of genital prolapse, who underwent surgical treatment using our modified colpocleisis operation. The control group comprised 70 other individuals with newly diagnosed uncomplicated cases of pelvic organ prolapse, who underwent surgical treatment using mesh implants.

Results: All patients underwent planned surgical treatment. The operated patients were monitored for 1–5 years. In the main group, the effectiveness of the operation was 100%, while the effectiveness of surgical treatment with a mesh implant in the control group was 95.7%. All patients in the main group had complete tissue healing. There were no cases of long-term complications or relapses in any of the patients.

Conclusions: the use of the modified colpocleisis operation for atypical types of pelvic organ prolapse is a highly effective method of prolapse correction. This, in combination with a simple execution technique, allows it for being offered as a basic method for vaginal access in patients without sexual activity.

Keywords

pelvic organ prolapse / colpocleisis / complications / vaginal hysterectomy / mesh implant

References

[1] Haylen BT, de Ridder D, Freeman RM, et al.; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. doi: 10.3109/9781439807217-111

[2] Haylen B.T., de Ridder D., Freeman R.M., et al.; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction // Neurourol Urodyn. 2010. Vol. 29, N 1. P. 4–20. doi: 10.3109/9781439807217-111

[3] Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–148. doi: 10.1097/AOG.0000000000000057

[4] Wu J.M., Vaughan C.P., Goode P.S., et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women // Obstet Gynecol. 2014. Vol. 123, N 1. P. 141–148. doi: 10.1097/AOG.0000000000000057

[5] Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–1790. doi: 10.1007/s00192-013-2169-9

[6] Barber M.D., Maher C. Epidemiology and outcome assessment of pelvic organ prolapsed // Int Urogynecol J. 2013. Vol. 24, N 11. P. 1783–1790. doi: 10.1007/s00192-013-2169-9

[7] Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190(1):27–32. doi: 10.1016/j.ajog.2003.07.017

[8] Handa V.L., Garrett E., Hendrix S., et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women // Am J Obstet Gynecol. 2004. Vol. 190, N 1. P. 27–32. doi: 10.1016/j.ajog.2003.07.017

[9] Bradley CS, Zimmerman MB, Qi Y, et al. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(4):848–854. doi: 10.1097/01.aog.0000255977.91296.5d

[10] Bradley C.S., Zimmerman M.B., Qi Y., et al. Natural history of pelvic organ prolapse in postmenopausal women // Obstet Gynecol. 2007. Vol. 109, N 4. P. 848–854. doi: 10.1097/01.aog.0000255977.91296.5d

[11] Wu JM, Hundley AF, Fulton RG, et al. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–1283. doi: 10.1097/AOG.0b013e3181c2ce96

[12] Wu J.M., Hundley A.F., Fulton R.G., et al. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050 // Obstet Gynecol. 2009. Vol. 114, N 6. P. 1278–1283. doi: 10.1097/AOG.0b013e3181c2ce96

[13] Lien KC, Mooney B, DeLancey JO, et al. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31–40. doi: 10.1097/01.AOG.0000109207.22354.65

[14] Lien K.C., Mooney B., DeLancey J.O., et al. Levator ani muscle stretch induced by simulated vaginal birth // Obstet Gynecol. 2004. Vol. 103, N 1. P. 31–40. doi: 10.1097/01.AOG.0000109207.22354.65

[15] Degtyareva YuA. Pelvic organ prolapse in women: risk factors, prognosis of clinical course of the disease [dissertation abstract]. Saint Petersburg; 2010. 25 p. (In Russ.) EDN: ZOBCEX [cited 2024 Nov 28] Available from: https://new-disser.ru/_avtoreferats/01004662736.pdf?ysclid=m2u8iloi26963986494

[16] Дегтярёва Ю.А. Пролапс тазовых органов у женщин: факторы риска, прогнозирование клинического течения заболевания: автореф. дисс. … канд. мед. наук. Санкт Петербург, 2010. 24 с. EDN: ZOBCEX Режим доступа: https://new-disser.ru/_avtoreferats/01004662736.pdf?ysclid=m2u8iloi26963986494

[17] Bychenko VV. Pelvic organ prolapse in women – hidden threat (literature review). Bulletin of Syktyvkar university. Series 2: Biology. Geology. Chemistry. Ecology. 2021;18(2):73–80. (In Russ.) EDN: OLJRBL doi: 10.34130/2306-6229-2021-2-73

[18] Быченко В.В. Пролапс тазовых органов у женщин – скрытая угроза (обзор литературы) // Вестник Сыктывкарского университета. Серия 2. Биология. Геология. Химия. Экология. 2021. № 2(18). С. 73–80. EDN: OLJRBL doi: 10.34130/2306-6229-2021-2-73

[19] Martynov AI, Nechaeva GI, Akatova EV, et al. National recommendations of the Russian Scientific Medical Society of Therapists for diagnostics, treatment and rehabilitation of patients with connective tissue dysplasia. Medical Bulletin of the North Caucasus. 2016;11(1):2–76. EDN: VVXSTR doi: 10.14300/mnnc.2016.11001

[20] Мартынов А.И., Нечаева Г.И., Акатова Е.В., и др. Национальные рекомендации Российского научного медицинского общества терапевтов по диагностике, лечению и реабилитации пациентов с дисплазиями соединительной ткани // Медицинский вестник Северного Кавказа. 2016. Т. 11, № 1. С. 2–76. EDN: VVXSTR doi: 10.14300/mnnc.2016.11001

[21] Smolnova TYu. Women’s genital prolapse and connective tissue disease. Clinical and experimental surgery. Journal named by Academician B.V. Petrovsky. 2015;2(8):53–64. (In Russ.) EDN: UMAUXT

[22] Смольнова Т.Ю. Пролапс гениталий и дисплазия соединительной ткани // Клиническая и экспериментальная хирургия. Журнал имени академика Б.В. Петровского. 2015. № 2(8). С. 53–64. EDN: UMAUXT

[23] Bogatyreva EV. Features of diagnostics and results of surgical treatment of rectocele in pelvic organ prolapse in women [dissertation abstract]. Saint Petersburg; 2010. 24 p. (In Russ.) EDN: OQLOZK [cited 2024 Nov 28] Available from: https://new-disser.ru/_avtoreferats/01004662503.pdf?ysclid=m2u8n3qlq7448392765

[24] Богатырёва Е.В. Особенности диагностики и результаты хирургического лечения ректоцеле при пролапсе тазовых органов у женщин: автореф. дис. … канд. мед. Наук. Санкт Петербург, 2010. 24 с. EDN: OQLOZK Режим доступа: https://new-disser.ru/_avtoreferats/01004662503.pdf?ysclid=m2u8n3qlq7448392765

[25] Hallock JL, Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin North Am. 2016;43(1):1–13. doi: 10.1016/j.ogc.2015.10.008

[26] Hallock J.L., Handa V.L. The Epidemiology of pelvic floor disorders and childbirth: an update // Obstet Gynecol Clin North Am. 2016. Vol. 43, N 1. P. 1–13. doi: 10.1016/j.ogc.2015.10.008

[27] Bø K, Anglès-Acedo S, Batra A, et al. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: pelvic floor muscle training. Int Urogynecol J. 2022;33(10):2633–2667. doi: 10.1007/s00192-022-05324-0

[28] Bø K., Anglès-Acedo S., Batra A., et al. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: pelvic floor muscle training // Int Urogynecol J. 2022. Vol. 33, N 10. P. 2633–2667. doi: 10.1007/s00192-022-05324-0

[29] Krissi H., Aviram A., Eitan R., et al. Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women. Int J Surg. 2015;20:75–79. doi: 10.1016/j.ijsu.2015.06.026

[30] Krissi H., Aviram A., Eitan R., et al. Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women // Intl J Surg. 2015. Vol. 20. P. 75–79. doi: 10.1016/j.ijsu.2015.06.026

[31] Collins S, Lewicky-Gaupp C. Pelvic organ prolapse. Gastroenterol Clin North Am. 2022;51(1):177–193. doi: 10.1016/j.gtc.2021.10.011

[32] Collins S., Lewicky-Gaupp C. Pelvic organ prolapse // Gastroenterol Clin North Am. 2022. Vol. 51, N 1. P. 177–193. doi: 10.1016/j.gtc.2021.10.011

[33] Hüsch T, Mager R, Ober F, et al. Quality of life in women of non-reproductive age with transvaginal mesh repair for pelvic organ prolapse: a cohort study. Int J Surg. 2016;33:36–41. doi: 10.1016/j.ijsu.2016.07.062

[34] Hüsch T., Mager R., Ober F., et al. Quality of life in women of non-reproductive age with transvaginal mesh repair for pelvic organ prolapse: a cohort study // Int J Surg. 2016. Vol. 33, Pt. A. Р. 36–41. doi: 10.1016/j.ijsu.2016.07.062

[35] Bezhenar VF, Palastin PM, Tolibova GKh. Vaginal erosions in the late stages after the placement of synthetic implants during gynecological surgeries: an immunohistochemical study. In: Reproductive potential of Russia: versions and controversies. Abstracts of the XI All-Russian scientific and practical seminar. 2018. Moscow: Media bureau Status Present; 2018. P. 34. (In Russ.) EDN: SILXQX

[36] Беженарь, В.Ф., Паластин П.М., Толибова Г.Х. Эрозии влагалища в отдаленные сроки после постановки синтетических имплантатов при гинекологических операциях: иммуногистохимическое исследование. В кн.: Репродуктивный потенциал России: версии и контраверсии. Тезисы XI Общероссийского научно-практического семинара. 2018. Москва: Медиабюро Статус Презенс, 2018. С. 34. EDN: SILXQX

[37] Bezhenar VF, Palastin PM, Tolibova GX. Vaginal erosions in the late stages after the placement of synthetic implants in gynecological surgeries. Russian Medical Journal. Medical Review. 2018;2(10):17–21. (In Russ.) EDN: YSXNZJ

[38] Беженарь, В.Ф., Паластин П. М., Толибова Г. Х. Эрозии влагалища в отдаленные сроки после постановки синтетических имплантатов при гинекологических операциях // Русский медицинский журнал. Медицинское обозрение. 2018. Т. 2, № 10. С. 17–21. EDN: YSXNZJ

[39] Makarov OV, Smetnik VP, Dobroxotova YE. Posthysterectomy syndrome. Moscow; 2000. (In Russ.)

[40] Макаров О.В., Сметник В.П., Доброхотова Ю.Э. Синдром постгистерэктомии. Москва, 2000. 267 с.

[41] Russian Society of Obstetricians and Gynecologists, All-Russian Public Organization “Russian Society of Urologists”. Prolapse of female genital organs: clinical guidelines. Moscow; 2021. (In Russ.)

[42] Российское общество акушеров-гинекологов, Общероссийская общественная организация «Российское общество урологов». Выпадение женских половых органов: клинические рекомендации. Москва, 2021.

[43] Kira KE, Bezhenar VF, Proxorova VS. Urethrovesical segment ultrasound for the efficacy evaluation of surgical treatment of stress urinary incontinence. Journal of Obstetrics and Women’s Diseases. 2020;69(6):43–48. EDN: TMMNRA doi: 10.17816/JOWD69643-48

[44] Кира К.Е., Беженарь В.Ф., Прохорова В.С. УЗИ уретровезикального сегмента как метод оценки эффективности хирургического лечения стрессового недержания мочи // Журнал акушерства и женских болезней. 2020. Т. 69, № 6. С. 43–48. EDN: TMMNRA doi: 10.17816/JOWD69643-48

[45] Palastin PM. Ways to prevent vaginal wall erosions during correction of genital prolapse with synthetic implants [dissertation abstract]. Saint Petersburg; 2019. 25 p. (In Russ.) [cited 2024 Nov 28]. Available from: https://www.1spbgmu.ru/images/home/universitet/Struktura/Soveti_i_Komissii/Dissertacii/2018/%D0%9F%D0%B0%D0%BB%D0%B0%D1%81%D1%82%D0%B8%D0%BD/%D0%90%D0%92%D0%A2%D0%9E%D0%A0%D0%95%D0%A4%D0%95%D0%A0%D0%90%D0%A2_%D0%9F%D0%B0%D0%BB%D0%B0%D1%81%D1%82%D0%B8%D0%BD_%D0%9F.%D0%9C.pdf?ysclid=m2ud04cqnr995177824

[46] Паластин П.М. Пути профилактики эрозий стенки влагалища при коррекции генитального пролапса синтетическими имплантатами: автореф. дис. … канд. мед. наук. Санкт-Петербург, 2019. 25 с. Режим доступа: https://www.1spbgmu.ru/images/home/universitet/Struktura/Soveti_i_Komissii/Dissertacii/2018/%D0%9F%D0%B0%D0%BB%D0%B0%D1%81%D1%82%D0%B8%D0%BD/%D0%90%D0%92%D0%A2%D0%9E%D0%A0%D0%95%D0%A4%D0%95%D0%A0%D0%90%D0%A2_%D0%9F%D0%B0%D0%BB%D0%B0%D1%81%D1%82%D0%B8%D0%BD_%D0%9F.%D0%9C.pdf?ysclid=m2ud04cqnr995177824 Дата обращения: 28.11.2024.

[47] Bataller E, Ros C, Anglès S, et al. Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh. Int Urogynecology J. 2019;30:545–555. doi: 10.1007/s00192-018-3702-7

[48] Bataller E., Ros C., Anglès S., et al. Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh // Int Urogynecology J. 2019. Vol. 30. P. 545–555 doi: 10.1007/s00192-018-3702-7

[49] Clancy C, Jordan P, Ridgway PF. Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence. Ir J Med Sci. 2019;188:1349–1356. doi: 10.1007/s11845-019-02008-5

[50] Clancy C., Jordan P., Ridgway P.F. Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence // Ir J Med Sci. 2019. Vol. 188. P. 1349–1356. doi: 10.1007/s11845-019-02008-5

[51] Kira KE. Efficiency of surgical treatment of stress urinary incontinence in women using synthetic implants and autologous tissues [dissertation abstract]. Saint Petersburg; 2020. 28 p. (In Russ.) EDN: EHDIHV

[52] Кира К.Е. Эффективность хирургического лечения стрессового недержания мочи у женщин с применением синтетических имплантатов и аутологичных тканей: автореф. дис. … канд. мед. наук. Санкт Петербург, 2020. 28 с. EDN: EHDIHV

[53] Lologaeva MS, Aryutin DG, Orazov MR, et al. Pelvic organ prolapse in xxi century. Obstetrics and gynecology. News, Opinions, Training. 2019;7(3):76–82 EDN: GKHBHK doi: 10.24411/2303-9698-2019-13011

[54] Лологаева М.С., Арютин Д.Г., Оразов М.Р., и др. Пролапс тазовых органов в XXI в. // Акушерство и гинекология: новости мнения, обучение. 2019. Т. 7, № 3(25). С. 76–82. EDN: GKHBHK doi: 10.24411/2303-9698-2019-13011

[55] Orazov MR, Toktar LR, Dostieva SM, et al. Pelvic organ prolapse - a problem without perfect solution. Difficult patient. 2019;17(8):23–27. EDN: AIXKQP doi: 10.24411/2074-1995-2019-10058

[56] Оразов М.Р., Токтар Л.Р., Достиева Ш.М., и др. Пролапс тазовых органов – проблема, не имеющая идеального решения // Трудный пациент. 2019. Т. 17, № 8–9. С. 23–27. EDN: AIXKQP doi: 10.24411/2074-1995-2019-10058

[57] Plekhanov AN, Bezhenar VF, Karachun AM, et al. Experience in surgical correction of genital prolapse caused by abdominoperineal operations for colon cancer in anamnesis. Journal of Obstetrics and Women’s Diseases. 2020;69(5):87–97. EDN: WKBRAE doi: 10.17816/JOWD69587-97

[58] Плеханов А.Н., Беженарь В.Ф., Карачун А.М., и др. Опыт хирургической коррекции генитального пролапса, обусловленного брюшно-промежностными операциями по поводу рака толстой кишки в анамнезе // Журнал акушерства и женских болезней. 2020. Т. 69, № 5. C. 87–97. EDN: WKBRAE doi: 10.17816/JOWD69587-97

[59] Plekhanov AN, Bezhenar VF, Epifanova TA, et al. Randomized comparative study of the effectiveness and safety of various bipolar devices during electrosurgical vaginal hysterectomy. Journal of Obstetrics and Women’s Diseases. 2021;70(2):45–54. EDN: GKZXOI doi: 10.17816/JOWD71084

[60] Плеханов А.Н., Беженарь В.Ф., Епифанова Т.А., и др. Рандомизированное сравнительное исследование эффективности и безопасности различных биполярных устройств при выполнении электрохирургической влагалищной гистерэктомии // Журнал акушерства и женских болезней. 2021. Т. 70, № 2. C. 45–54. EDN: GKZXOI doi: 10.17816/JOWD71084

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