Number №2, 2019 - page 164-169

Possibilities of surgical reconstruction sacro-utero-cardinal ligamentous complex in the treatment of bladder hyperactivity DOI: 10.29188/2222-8543-2019-11-2-164-168

Shkarupa D.D., Zayceva A.O., Kubin N.D., Kovalev G.V.
Information about authors:
  • Shkarupa D.D. – Dr. Sc., Deputy Director for medical care, Chief Urologist of Saint-Petersburg State University Clinic of advanced medical technologies n.a. Nikolay I. Pirogov. Assistant of the Department of Urology of the North-Western Medical University n.a. I.I. Mechnikov, shkarupa.dmitry@mail.ru, ORCID 0000-0003-0489-3451
  • Zaytseva A.O. – urologist of the Department of Urology, Saint-Petersburg State University Clinic of advanced medical technologies n.a. Nikolay I. Pirogov; zaytseva-anast@mail.ru, ORCID 0000-0002-8763-6188
  • Kubin N.D. – PhD, Urologist of the Department of Urology, Saint-Petersburg State University Clinic of advanced medical technologies n.a. Nikolay I. Pirogov; nikitakubin@gmail.com, ORCID 0000-0001-5189-4639
  • Kovalev G.V. – resident of the Department of Urology, Saint-Petersburg State University Clinic of advanced medical technologies n.a. Nikolay I. Pirogov; kovalev2207@gmail.com, ORCID 0000-0002-1300-5156
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Overactive bladder (OAB) significantly decreases quality of life for many patients worldwide. However, today there is no «gold standard» for treatment of this condition. This fact urges us to look for new methods of treatment. OAB symptoms are often encountered in patients with pelvic organ prolapse (POP). This issue is most important for patients with minor prolapse (stages 1-2), when there are no indications for large scale surgical reconstruction using implants, but patients’ quality of life is already impaired due to OAB.

According to integral theory by P. Petros, even small tension of vaginal fasciae and ligaments in pelvic prolapse may lead to activation of stretching receptors and initiation of micturition reflex. Using the tampon test we selected patients with 1-2 stage of POP to perform surgical reconstruction of sacral-uterinecardinal complex. Our analysis has shown that patients from the young age group (25-55 years) experienced resolution of both pelvic prolapse and OAB symptoms for 18 month period.

In patients from older age group (56-82 лет) ligamentoplasty led to resolution of POP and OAB for no more than 6 months, after which the symptoms returned. It is supposed that lower concentration of estrogen in tissues leads to the recurrence of POP and, consequently, associated OAB. Thus, plication of sacral-uterine-cardinal complex may be recommended to young women (pre-menopause) as an alternative modality of treatment for OAB.

Authors declare lack of the possible conflicts of interests

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overactive bladder, pelvic organ prolapse, surgical reconstruction of the pelvic floor, ligamentplasty, sacro-utero-cardinal ligamentous complex, integral theory

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