Topical issues of surgical treatment of pelvic floor dysfunction. A literature review

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Abstract

This article presents a review of the current literature on the problem of omission and prolapse of the internal genitalia in women. Patients diagnosed with pelvic organ prolapse need pelvic floor plastic surgery. Currently, in spite of the extensive experience in managing this category of patients, there is still no single and unambiguous approach to the choice of surgical treatment tactics.

This review describes the latest information on the etiopathogenesis of pelvic floor supporting apparatus lesions, namely, systemic connective tissue dysplasia as the main development factor. Prospective development of genetic and immunohistochemical marker diagnosis is the key to individual selection of treatment options for this multidisciplinary problem. The results of interventions are characterized by extreme variability in terms of both effectiveness and the frequency of intra- and postoperative complications. The treatment of rare forms of prolapse after surgery for rectal cancer also raises many questions. The current multitude of types of surgical interventions for genital prolapse and variants of pelvic floor defect closure is constantly being modified. To date, there is no universal treatment option, and all available techniques have both advantages and disadvantages, as well as limited application due to the risk of somatic complications, high recurrence rate, and the need for expensive equipment and a highly qualified surgeon.

New research is needed, taking into account the current knowledge about the cellular and molecular mechanism of the lesion of the pelvic floor supporting apparatus. All of this will improve the methods of correction of pelvic organ prolapse in both typical and rare forms caused by iatrogenic factors. As a result, this may lead to an improvement in the quality of life of such patients.

About the authors

Vitaly F. Bezhenar

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929
SPIN-code: 8626-7555
Scopus Author ID: 57191963583
ResearcherId: R-7055-2017

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Andrey N. Plekhanov

Academician I.P. Pavlov First St. Petersburg State Medical University; St. Petersburg Clinical Hospital of the Russian Academy of Sciences; F.I. Inozemtsev Academy of Medical Education

Email: a_plekhanov@mail.ru
ORCID iD: 0000-0002-5876-6119
SPIN-code: 1132-4360

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Fedor V. Bezhenar

St. Petersburg Clinical Hospital of the Russian Academy of Sciences

Email: fbezhenar@gmail.com
ORCID iD: 0000-0001-5515-8321
SPIN-code: 6074-5051
Russian Federation, Saint Petersburg

Tatiana A. Epifanova

St. Petersburg Clinical Hospital of the Russian Academy of Sciences

Author for correspondence.
Email: epifanova-tatiana@mail.ru
ORCID iD: 0000-0003-1572-1719
SPIN-code: 5106-9715

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

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2. Fig. 1. Three-level support of the pelvic floor (published at: https://probolezny.ru/vypadenie-matki/)

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3. Fig. 2. Pubocervical fascia (published at: https://uroportal.ru/upload/iblock/f67/f676dd589c7470671864a542a12d6dff.pdf)

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4. Fig. 3. Paravaginal defect (published at: https://uroportal.ru/upload/iblock/f67/f676dd589c7470671864a542a12d6dff.pdf)

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5. Fig. 4. Dissection line for standard (a) and extralevator (b) abdominoperineal excision (Han JG, Wang ZJ, Wei GH, et al. Trans-perineal minimally invasive approach during extralevator abdominoperineal excision for advanced low rectal cancer: A retrospective cohort study. Asian J Surg. 2020;43(8):819–825. DOI: 10.1016/j.asjsur.2019.11.004)

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6. Fig. 5. Perineal wound after extralevator abdominoperineal excision. Observation and photography by A.M. Karachun (N.N. Petrov National Research Center of Oncology, Saint Petersburg, 2014)

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Copyright (c) 2023 Bezhenar V.F., Plekhanov A.N., Bezhenar F.V., Epifanova T.A.

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