Aim of the study: to develop the criteria forselection of patientsfor optimal surgical treatment of genital prolapse using autologous tissue or polypropylene meshes with a vaginal approach.
Material and methods. We performed a prospective study which included 93 patients(age: 46-81 years),whowere divided in two groups: group 1 (n=43) - transvaginal operation using autologous tissue; group 2 (n=50) - transvaginal extraperitoneal colpopexywith a perforated extra-light(surface density 19 g/m2 ) polypropylene mesh (Russian Federation patent №2538796, invention claim №2013102790/14 made on 05.02.2013, published on 10.01.2015). All patients underwent combined clinical and instrumental work-up, including pelvic floor ultrasonography, prior to surgery.
Results. Six months afterthe surgery prolapse recurrencewasfound in 55,8% patientsfrom group I and in 10,0% patientsfrom group II (p<0,05). In patients from group I most of prolapse recurrences (53,5%) were found in operated site, unlike the patients who underwent mesh surgery (0% in group II, p<0,05),which reflectslesser efficacy of autologoustissue surgery. Statistical analysis has proven a higher(17-fold) efficacy of transvaginal extraperitoneal colpopexy with polypropylene mesh when compared with autologous plasty of anterior vaginal wall(7,0% vs 51,2%). In group I there was a strong correlation between genital prolapse recurrence and severity of connective tissue dysplasia (r=0,78; p<0,01), and with duration of primary condition (r=0,73; p<0,01). Pre-surgery perineal sonography in patientsfrom group I hasshown significantly worse size parameters of pelvic floorstructuresinwomenwith recurrent prolapse than in patientswithout recurrence. We found a correlation between damage to pelvic floor structures on sonography and severity of connective tissue dysplasia in group II patients,which significantly influenced genital prolapse recurrence in nonoperated sites (r=0,47; p<0,01).
Conclusion. Transvaginalsurgery for genital prolapse using polypropylene meshes is rational for patients with recurrent cases, with severe or moderate connective tissue dysplasia, duration of primary condition over 10 years and ultrasound features of pelvic floor insufficiency: height of tendinous center less than 0,7±0,3 cm, width of m. bulbocavernosus less than 0,7±0,2 cm and levator ani diastasis over 2,8±0,5 cm.
Authors declare lack of the possible conflicts of interests