Comparative analysis of methods of surgical correction of post-hysterectomy pelvic organ prolapse

BACKGROUND: The incidence of prolapse after hysterectomy requiring surgical intervention is estimated at 36 cases per 10,000 women. A universal surgical treatment method for post-hysterectomy pelvic organ prolapse is lacking, prompting the need for new approaches.

AIM: To comparatively analyze the results of laparoscopic sacrocolpopexy, sacrospinous fixation, and the developed new method of surgical correction of pelvic organ prolapse after hysterectomy.

MATERIAL AND METHODS: This prospective non-randomized study included 57 patients with stage II, III, or IV symptomatic post-hysterectomy prolapse of the pelvic organs who were admitted at the clinical hospital RZD-Medicine in Tula, Russia, between August 2019 and September 2023. The first group (n=18) consisted of women who underwent surgical correction of post-hysterectomy pelvic organ prolapse in a newly developed method; the second group (n=19) included women who underwent laparoscopic promontofixation according to the conventional technique; and the third group (n=20) involved patients who underwent installation of an apical sling using a UroSling-1 mesh endoprosthesis (Lintex LLC, St. Petersburg). The patients’ quality of life was assessed using specialized validated questionnaires: Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Patients were asked to complete questionnaires before surgery and 12 and 24 months after surgical correction of PGP. The patients were invited for a follow-up examination after 1, 6, 12, and 24 months.

RESULTS: The duration of the operation in the second group significantly exceeded the indicators of the first and third groups. The average duration of hospital stay of patients was 4.4±0.6 (95% CI: 4.1–4.7) bed days in the first group, 4.9±1.1 (95% CI: 4.6–5.3) in the second, and 4.6±0.6 (95% CI: 4.3–4.9) in the third. The differences were insignificant (p^1–2=0.437; p^1–3=0.137; p^2–3=0.235). The anatomical results after 24 months at points Aa and Ba showed significant differences. At point Aa, p^1–3=0.007 and p^2–3=0.004, and at point Ba, p^1–3=0.032 and p^2–3=0.041. A comparative assessment of the questionnaire data before surgery and 12 and 24 months after surgery showed a significant improvement in the quality of life of patients in the three groups.

CONCLUSION: The proposed method of correction of post-hysterectomy pelvic organ prolapse provides high anatomical and functional results and reduces the posibility of repeated surgical intervention for recurrence.