Email this article Results of surgical correction for cervical elongation with vaginal wall prolapse in patients of reproductive and premenopausal age
- Authors: Ivanova V.V.1, Ishchenko A.I.1, Ishchenko A.A.2, Khokhlova I.D.1, Dzhibladze T.A.1, Gorbenko O.Y.1, Svidinskaya E.A.1, Gadaeva I.V.1, Malyuta E.G.2, Asambaeva A.1
-
Affiliations:
- I.M. Sechenov First Moscow State Medical University
- Medical and Rehabilitation Center
- Issue: Vol 10, No 1 (2023)
- Pages: 39-48
- Section: Original study articles
- URL: https://journals.rcsi.science/2313-8726/article/view/218820
- DOI: https://doi.org/10.17816/2313-8726-2023-10-1-39-48
- ID: 218820
Cite item
Abstract
BACKGROUND: The problem of cervical elongation is becoming increasingly important due to the rising prevalence of pelvic organ prolapse. In Russia, descent and prolapse of pelvic organs account for 39% of all gynecological pathologies.
AIM: This study aimed to compare the immediate and long-term results of surgical treatment for cervical elongation in combination with vaginal wall prolapse in patients of three clinical groups.
MATERIALS AND METHODS: A total of 105 patients aged 30 to 55 years with a combination of cervical elongation and vaginal wall prolapse of degrees I–II were followed up. The patients were divided into three clinical groups based on the implemented surgical techniques, including group 1 (n=36) with Moscow surgery, group 2 (n=35) with modification of the Manchester surgery using synthetic implants, and group 3 (n=34) with Manchester surgery.
The patients underwent a comprehensive clinical examination, surgical treatment, and follow-up in the early and long-term postoperative periods (1, 6, 12, 24, and 36 months). The efficacy of surgical treatment was assessed using a questionnaire. During dynamic monitoring, a gynecological examination with a Valsalva maneuver, and transperineal, and transvaginal echography were performed.
RESULTS: During the first month after the surgery, patients noted irregular dragging pains in the perineum and/or inguinal region every second. A frequent urge to urinate was reported in 16.7%, 17.1%, and 17.6% of patients in groups 1, 2, and 3, respectively. A further survey revealed that the surgical treatment results were satisfactory, as it had a positive effect on the quality of life and mood and contributed to an increase in social and sexual activity. According to the physical examination, there were no signs of prolapse recurrence and mesh-associated complications. Erosion of the anterior vaginal wall over the polypropylene endoprosthesis was detected 6 months after the surgery in 3 (8.6%) patients of group 2.
Genital prolapse recurrence was diagnosed after 12–36 months in 7 (20.6%) patients of group 3. After 36 months, degree I prolapse of the posterior (n=1) and anterior (n=1) walls of the vagina was revealed in patients of groups 1 and 2, respectively.
Full Text
##article.viewOnOriginalSite##About the authors
Viktoriya V. Ivanova
I.M. Sechenov First Moscow State Medical University
Email: vikiv3011@yandex.ru
ORCID iD: 0000-0002-0917-7713
Doctor
Russian Federation, MoscowAnatoliy I. Ishchenko
I.M. Sechenov First Moscow State Medical University
Email: 7205502@mail.ru
ORCID iD: 0000-0003-3338-1113
MD, Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology
Russian Federation, MoscowAnton A. Ishchenko
Medical and Rehabilitation Center
Email: ra2001_2001@mail.ru
ORCID iD: 0000-0002-4476-4972
MD, Cand. Sci. (Med.), Head of the Center of Gynecology and Reproductive Technologies
Russian Federation, MoscowIrina D. Khokhlova
I.M. Sechenov First Moscow State Medical University
Author for correspondence.
Email: irhohlova5@gmail.com
ORCID iD: 0000-0001-8547-6750
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowTea A. Dzhibladze
I.M. Sechenov First Moscow State Medical University
Email: djiba@bk.ru
ORCID iD: 0000-0003-1540-5628
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowOksana Yu. Gorbenko
I.M. Sechenov First Moscow State Medical University
Email: go2601@mail.ru
ORCID iD: 0000-0002-3435-4590
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowEvgeniya A. Svidinskaya
I.M. Sechenov First Moscow State Medical University
Email: svidinskaya@gmail.com
ORCID iD: 0000-0002-2368-1932
MD, Cand. Sci. (Med.)
Russian Federation, MoscowIrina V. Gadaeva
I.M. Sechenov First Moscow State Medical University
Email: irina090765@gmail.com
ORCID iD: 0000-0003-0144-4984
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowElena G. Malyuta
Medical and Rehabilitation Center
Email: egma@list.ru
ORCID iD: 0000-0003-0098-0830
MD, Cand. Sci. (Med.), Head of the Gynecological Department
Russian Federation, MoscowAilar Asambaeva
I.M. Sechenov First Moscow State Medical University
Email: dr.ailar7@gmail.com
ORCID iD: 0000-0001-5399-7586
Post-Graduate Student
Russian Federation, MoscowReferences
- Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 5thInternarional Consultation on Incontinence. Paris: Health Publication Ltd; 2013.
- Yuk J-S, Lee JH, Hur J-Y, Shin J-H. The prevalence and treatment pattern of clinically diagnosed pelvic organ prolapse: a Korean National Health Insurance Database-based cross-sectional study 2009–2015. Sci Rep. 2018;8(1):1334. doi: 10.1038/s41598-018-19692-5
- Masenga GG, Shayo BC, Rasch V. Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population based study in Tanzanian rural community. PLoS One. 2018;13(4):e0195910. doi: 10.1371/journal.pone.0195910
- Buianova SN, Shchukina NA, Zubova ES, Sibryaeva VA, Rizhinashvili ID. Genital prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2017;17(1):3745. (In Russ.). doi: 10.17116/rosakush201717137-45
- Ishchenko AI, Ivanova VV, Ishchenko AA, et al. A new method of organ-preserving surgical correction of cervical elongation using titanium mesh implants. The “Moscow” surgery. Gynecology, Obstetrics and Perinatology. 2021;20(4):84–92. (In Russ). doi: 10.20953/1726-1678-2021-4-84-92
- Buyanova SN, Schukina NA, Petrosyan EI, Dub NV. Management tactics for patients with cicatricial deformity and elongation of the cervix in combination with pelvic floor weakness. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(4):5257. (In Russ.). doi: 10.17116/rosakush20202004152
- Ishchenko AI, Aleksandrov LS, Ishchenko AA, Hudoley EP. Method of Surgical Management of Genital Prolapse with Cervical Elongation. Annals of the Russian Academy of Medical Sciences. 2016;71(6):413–419. (In Russ). doi: 10.15690/vramn727
- Iglesia CB, Smithling KR. Pelvic Organ Prolapse. Am Fam Physician. 2017;96(3):179–185.
- Patent RUS № 2533983 С2/ 27.01.2014. Byul. № 3. Ishchenko AI, Ishchenko AA, Gorbenko OYu, et al. Sposob korrektsii prolapsa genitalii v sochetanii s elongatsiei sheiki matki. Available from: https://patents.s3.yandex.net/RU2533983C2_20141127.pdf (In Russ).
- Ellington DR, Richter HE. Indications, contraindications, and complications of mesh in surgical treatment of pelvic organ prolapse. Clin Obstet Gynecol. 2013;56(2):276–288. doi: 10.1097/GRF.0b013e318282f2e8
- Ishchenko AI, Shulchina IV, Ishchenko AA, Zhumanova EN, Gorbenko OYu. Mesh-associated complications. Risk factors. V.F. Snegirev Archives of Obstetrics and Gynecology. 2014;1(2):4–7. (In Russ).
- Patent RUS № 2755668 С1/ 09.07.2021. Byul. № 26. Ishchenko AI, Ishchenko AA, Ivanova VV, et al. Method for surgical treatment of pelvic organ prolapse in combination with cervical elongation (Moscow operation). Available from: https://patents.s3.yandex.net/RU2755668C1_20210920.pdf (In Russ).
- Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) ― a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75-81.
- 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. (In Russ). doi: 10.15690/vramn1123
- Korshunov MYu, Sazykina EI. PD-QL questionnaire ― validated instrument for symptoms and quality of life assessment in patients with pelvic organ prolapse. Journal of Obstetrics and Women’s Diseases. 2008;57(3):86–93. (In Russ).
- Kostyuchek DF, Gordeladze AS, Klyukovkina AS. Issues of the pathogenesis of cervical elongation (clinical-morphological and immunohistochemical study). Journal of Obstetrics and Women’s Diseases. 2005;54(3):5–11.
- Smolnova TYu. Women’s genital prolapse and connective tissue disease. Clin Experiment Surg Petrovsky J. 2015;2:53–64.
- Yashchuk АG, Musin II, Fatkullina IB, et al. Clinical and genetic parallels between connective tissue disease, genital prolapse and joint hypermobility syndrome. Gynecology, Obstetrics and Perinatology. 2018;17(4):31–35. (In Russ). doi: 10.20953/1726-1678-2018-4-31-35
- Hsiao SM, Chang TC, Chen CH, et al. Risk factors for coexistence of cervical elongation in uterine prolapse. Eur J Obstet Gynecol Reprod Biol. 2018;229:94–97. doi: 10.1016/j.ejogrb.2018.08.011
- Berger MB, Ramanah R, Guire KE, DeLancey JOL. Is cervical elongation associated with pelvic organ prolapse? Int Urogynecol J. 2012;23(8):1095–1103. doi: 10.1007/s00192-012-1747-6
- Guseva YS. Modern approaches to the problem of genital prolapse by vaginal access use of synthetic materials in urogynecology. Journal of Obstetrics and Women’s Diseases. 2013;62(2):51–62. (In Russ). doi: 10.17816/JOWD62251-62
- Chechneva MA, Barto RA, Budykina TS, Krasnopolskaya IV, Abramyan KN. Current view of pathogenesis, diagnosis and management of genital prolapse and its complications: a review of the literature. Pathogenesis. 2014;12(4):4–9. (In Russ).
- Ishchenko AI, Aleksandrov LS, Ishchenko AA, et al . Anterior colporrhaphy with titanium mesh implants. The first experience. Gynecology, Obstetrics and Perinatology. 2019;18(2):5–12. (In Russ). doi: 10.20953/1726-1678-2019-2-5-12
Supplementary files
