Bilateral transobturator hysterosuspension using titanium tape-shaped mesh implants in women with apical prolapse of the internal genitalia

Abstract

BACKGROUND: Pelvic organ prolapse is a common pathology with several relapses of the disease after surgical treatment using exclusively self-tissues, which necessitates the development of new surgical techniques using durable and biological inert materials.

AIM: To evaluate the effectiveness and safety of an original surgical technique for apical prolapse correction in patients of reproductive and pre- and postmenopausal age.

MATERIAL AND METHODS: Twenty-nine patients were examined and operated on using a developed original technique with the use of narrow tape-shaped titanium mesh implants.

RESULTS: Follow-up was conducted at 1, 6, 12, and 24 months postoperatively. Comparison of patient survey indicators in the pre- and postoperative periods showed an improvement in the patients’ quality of life and an increase in their social and sexual activity. During the first month, 15 (51.7%) patients reported intermittent pulling pains in the perineal and/or inguinal–femoral folds, and 4 (13.8%) reported frequent urination. Clinical examination revealed complete preservation of the surgical correction of prolapse in all patients. Gynecological and rectal examinations and transperineal and transvaginal echography did not show displacement of pelvic organs or titanium implants. Mesh-associated complications were not noted during the observation period.

CONCLUSION: The developed original technique for surgical correction of second-degree apical prolapse with the use of narrow ribbon-shaped titanium mesh implants is effective and safe. This is evidenced by the normalization of the uterus position in the pelvis, absence of displacement of pelvic organs in the near and distant postoperative periods, and absence of mesh-associated complications during the observation time.

Keywords

pelvic organ prolapse / mesh implants / surgical correction of POP

References

[1] Buyanova SN, Shchukina NA, Zubova ES, et al. Genital prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2017;17(1):37–45. EDN: YFQBKD doi: 10.17116/rosakush201717137-45

[2] Буянова С.Н., Щукина Н.А., Зубова Е.С., и др. Пролапс гениталий // Российский вестник акушера-гинеколога. 2017. Т. 17, № 1. С. 37–45. EDN: YFQBKD doi: 10.17116/rosakush201717137-45

[3] Buyanova SN, Shchukina NA, Zubova ES, et al. Genital prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2017;17(1):37–45. EDN: YFQBKD doi: 10.17116/rosakush201717137-45

[4] Ishchenko AI, Aleksandrov LS, Ishchenko AA, et al. Surgical correction of prolapse of anterior wall of the vagina and cervix using titanium mesh implants. Annals of the Russian Academy of Medical Sciences. 2020;75(1):18–26. EDN: XHWXGZ doi: 10.15690/vramn1123

[5] Ищенко А.И., Александров Л.С., Ищенко А.А., и др. Хирургическая коррекция опущения передней стенки влагалища и шейки матки при помощи сетчатых титановых имплантатов // Вестник РАМН. 2020. Т. 75, № 1. С. 18–26. EDN: XHWXGZ doi: 10.15690/vramn1123

[6] Ishchenko AI, Aleksandrov LS, Ishchenko AA, et al. Surgical correction of prolapse of anterior wall of the vagina and cervix using titanium mesh implants. Annals of the Russian Academy of Medical Sciences. 2020;75(1):18–26. EDN: XHWXGZ doi: 10.15690/vramn1123

[7] Malkhasian VA, Kasian GR, Sumerova NM. The anatomic and functional results of surgical correction of pelvic organ prolapse, by transvaginally implanting a synthetic mesh prosthesis: a prospective study in 105 patients. Russian Bulletin of Obstetrician-Gynecologist. 2012;12(1):70–74. EDN: PEJSBR

[8] Малхасян В.А., Касян Г.Р., Сумерова Н.М. Анатомические и функциональные результаты хирургической коррекции пролапса тазовых органов с помощью трансвагинальной имплантации синтетического сетчатого протеза: проспективное исследование у 105 пациенток // Российский вестник акушера-гинеколога. 2012. Т. 12 № 1. С. 70–74. EDN: PEJSBR

[9] Malkhasian VA, Kasian GR, Sumerova NM. The anatomic and functional results of surgical correction of pelvic organ prolapse, by transvaginally implanting a synthetic mesh prosthesis: a prospective study in 105 patients. Russian Bulletin of Obstetrician-Gynecologist. 2012;12(1):70–74. EDN: PEJSBR

[10] Tijdink MM, Vierhout ME, Heesakkers JP, Withagen MI. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. 2011;22(11):1395–1404. doi: 10.1007/s00192-011-1476-2

[11] Tijdink M.M., Vierhout M.E., Heesakkers J.P., Withagen M.I. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh // Int Urogynecol J. 2011. Vol. 22, N 11. P. 1395–1404. doi: 10.1007/s00192-011-1476-2

[12] Tijdink MM, Vierhout ME, Heesakkers JP, Withagen MI. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. 2011;22(11):1395–1404. doi: 10.1007/s00192-011-1476-2

[13] 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

[14] De Tayrac R., Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention // Int Urogynecol J. 2013. Vol. 24, N 11. P. 1859–1872. doi: 10.1007/s00192-013-2177-9

[15] 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

[16] Persu C, Chapple CR, Cauni V, et al. Pelvic organ prolapse quantification system (POP-Q) — a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75–81.

[17] Persu C., Chapple C.R., Cauni V., et al. Pelvic organ prolapse quantification system (POP-Q) — a new era in pelvic prolapse staging // J Med Life. 2011. Vol. 4, N 1. P. 75–81.

[18] Persu C, Chapple CR, Cauni V, et al. Pelvic organ prolapse quantification system (POP-Q) — a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75–81.

[19] Kazantsev AA, Parshikov VV, Shemyatovsky KA, et al. The titanium-containing mesh as a perspective group of implants for abdominal wall repair. Pirogov Russian Journal of Surgery. 2016;(4):86–95. EDN: WANEWN doi: 10.17116/hirurgia2016486-95

[20] Казанцев А.А., Паршиков В.В., Шемятовский К.А., и др. Титансодержащие сетчатые эндопротезы как перспективная группа имплантатов для пластики брюшной стенки // Хирургия. Журнал им. Н.И. Пирогова. 2016. № 4. С. 86–95. EDN: WANEWN doi: 10.17116/hirurgia2016486-95

[21] Kazantsev AA, Parshikov VV, Shemyatovsky KA, et al. The titanium-containing mesh as a perspective group of implants for abdominal wall repair. Pirogov Russian Journal of Surgery. 2016;(4):86–95. EDN: WANEWN doi: 10.17116/hirurgia2016486-95

[22] Chechneva MA, Barto RA, Budykina TS, et al. Current view of pathogenesis, diagnosis and management of genital prolapse and its complications. Pathogenesis. 2014;12(4):4–9. EDN: UJGAUT

[23] Чечнева М.А., Барто Р.А., Будыкина Т.С., и др. Современные представления о патогенезе, диагностике и способах коррекции пролапса гениталий и его осложнений // Патогенез. 2014. Т. 12, № 4. С. 4–9. EDN: UJGAUT

[24] Chechneva MA, Barto RA, Budykina TS, et al. Current view of pathogenesis, diagnosis and management of genital prolapse and its complications. Pathogenesis. 2014;12(4):4–9. EDN: UJGAUT

[25] Abramyan KN. Prevention and treatment of complications of extraperitoneal vaginopexy (Prolift operation) [dissertation]. Moscow; 2011. Available from: https://new-disser.ru/_avtoreferats/01005084780.pdf (In Russ.) EDN: QFKFXZ

[26] Абрамян К.Н. Профилактика и лечение осложнений экстраперитонеальной вагинопексии (операции Prolift): дис. ... канд. мед. наук. Москва, 2011. Режим доступа: https://new-disser.ru/_avtoreferats/01005084780.pdf EDN: QFKFXZ

[27] Abramyan KN. Prevention and treatment of complications of extraperitoneal vaginopexy (Prolift operation) [dissertation]. Moscow; 2011. Available from: https://new-disser.ru/_avtoreferats/01005084780.pdf (In Russ.) EDN: QFKFXZ

[28] Korshunov MYu, Sazykina EI. PD-QL Questionnaire — validates instrument for symptoms and quality of life assessment in patients with pelvic organ prolapse. Journal of Obstetrics and Womans Diseases. 2008;57(3):86–93. EDN: JVZIER

[29] Коршунов М.Ю., Сазыкина Е.И. Опросник ПД-КЖ — валидированный способ оценки симптомов дисфункций тазового дна и качества жизни у пациенток с пролапсом тазовых органов // Журнал акушерства и женских болезней. 2008. Т. 57, № 3. С. 86–93. EDN: JVZIER

[30] Korshunov MYu, Sazykina EI. PD-QL Questionnaire — validates instrument for symptoms and quality of life assessment in patients with pelvic organ prolapse. Journal of Obstetrics and Womans Diseases. 2008;57(3):86–93. EDN: JVZIER

RIGHTS & PERMISSIONS

Eco-Vector