10-year Experience of Combined Surgical Treatment of Severe Pelvic Organ Prolapse in Women

Study Objective: to compare the effectiveness of two methods of surgical treatment of severe forms of pelvic organ prolapse (POP) in women — the original method with the combined use of own tissues and a mesh implant and the traditional method with ventricular fixation of the uterus with a nylon thread.
Study Design: Prospective cohort comparative study in parallel groups.
Materials and Methods. The study was conducted in 2012–2021. The sample included 456 patients with a verified diagnosis of “pelvic organ prolapsed” (N81.2, II and III in classification of Pelvic Organ Prolapsed Quantification), complicated by a different combination of anterior, apical and posterior prolapses. The main group included 116 women operated on according to the original technique with the combined use of their own tissues (vaginal stage) and lateral ventrofixation of the uterus/cervix with a mesh implant was performed retroperitoneal to aponeurosis in the iliac regions. The second group (comparison) included 340 patients who also underwent a two-stage operation (according to the traditional method), but the abdominal stage consisted in ventrofixation of the uterus/cervix to aponeurosis of the anterior abdominal wall in the suprapubic region with a nylon thread. The frequency of relapses during the entire follow-up period and the quality of life were assessed according to the questionnaire “Pelvic Organ Prolapse — Quality of Life” (PT-QL) during the two years after surgery.
Study Results. The frequency of relapses after surgery with uterine ventrofixation to aponeurosis in the suprapubic region with a nylon ligature (11/64; 17.2%) was statistically more significant than with the use of a mesh implant according to the original technique (3/116; 2.6%) (p < 0.001). The quality of life after treatment was higher in the main group in the first days after surgery due to a statistically significant smaller number of patients with dysuric symptoms (7/116; 63%) in contrast to the comparison group, where more than half of the operated patients noted urinary retention 76,5% (260/340) (p < 0.001). In the long-term follow-up periods, there were no statistically significant differences in the patients of the compared groups according to the results of the PT-QL survey (p > 0.05).
Conclusion. The developed method of surgical treatment of POP with the combined use of own tissues and a mesh implant provided a reduction in the frequency of relapses of the disease and a higher quality of life in the early postoperative period.

1. Elodie M., Chéret A., Marcus-Braun N., Von Theobald P. Laparoscopic sacro(hystero)colpopexy: twenty years after. Women’s Health Gynecol. 2016; 2(4): 028.

2. Khayyami Y., Elmelund M., Lose G., Klarskov N. De novo urinary incontinence after pelvic organ prolapse surgery — a national database study. Int. Urogynecol. J. 2020; 31(2): 305–8. DOI: 10.1007/s00192-019-04041-5

3. Ishchenko A.I., Gavrilova T.V., Ishchenko A.A., Gorbenko O.Yu. et al. Vaginal extirpation of the uterus using implants made of titanium silk to prevent recurrence of the disease. V.F. Snegireva. Archives of Obstetrics and Gynecology. 2021; 8(2): 101–8. (in Russian) DOI: 10.17816/2313-8726-2021-8-2-101-108

4. Maher C., Feiner B., Baessler K., Christmann-Schmid C. et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst. Rev. 2016; 2(2): CD012079. DOI: 10.1002/14651858.CD012079

5. Yashchuk A.G., Musin I.I., Fatkullina I.B., Trubin V.B. et al. Clinical and genetic parallels between connective tissue disease, genital prolapse and joint hypermobility syndrome. Gynecology, Obstetrics and Perinatology. 2018; 17(4): 31–5. (in Russian) DOI: 10.20953/1726-1678-2018-4-31-35

6. Dällenbach P. To mesh or not to mesh: a review of pelvic organ reconstructive surgery. Int. J. Womens Health. 2015; 7: 331–43. DOI: 10.2147/IJWH.S71236

7. Vasin R.V., Filimonov V.B., Vasina I.V. Genital prolapse: contemporary aspects of surgical treatment (literature review). Experimental and Clinical Urology. 2017; 1: 104–15. (in Russian)

8. Shkarupa D.D., Kubin N.D., Shapovalova E.A., Zaitseva A.O. et al. Combined pelvic floor repair in levels I and II support defects: posterior intravaginal sling and subfascial colporrhaphy. Obstetrics and Gynecology. 2016; 8: 99–105. (in Russian) DOI: 10.18565/aig.2016.8.99-105

9. Abramov Y., Gandhi S., Goldberg R.P., Botros S.M. et al. Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet. Gynecol. 2005; 105(2): 314–8. DOI: 10.1097/01.AOG.0000151990.08019.30

10. Cao Q., Chen Y.S., Ding J.X., Hu C.D. et al. Long-term treatment outcomes of transvaginal mesh surgery versus anterior-posterior colporrhaphy for pelvic organ prolapse. Aust. N. Z. J. Obstet. Gynaecol. 2013; 53(1): 79–85. DOI: 10.1111/ajo.12040

11. Gillor M., Langer S., Dietz H.P. Long-term subjective, clinical and sonographic outcomes after native-tissue and mesh-augmented posterior colporrhaphy. Int. Urogynecol. J. 2019; 30(9): 1581–5. DOI: 10.1007/s00192-019-03921-0

12. Costantini E., Mearini L., Lazzeri M., Bini V. et al. Laparoscopic versus abdominal sacrocolpopexy: a randomized, controlled trial. J. Urol. 2016; 196(1): 159–65. DOI: 10.1016/j.juro.2015.12.089

13. Mangir N., Roman S., Chapple C.R., MacNeil S. Complications related to use of mesh implants in surgical treatment of stress urinary incontinence and pelvic organ prolapse: infection or inflammation? World J. Urol. 2020; 38(1): 73–80. DOI: 10.1007/s00345-019-02679-w

14. Erema V.V., Buyanova S.N., Mgeliashvili M.V., Petrakova S.A. et al. Mesh-associated complications in the correction of pelvic organ prolapse and stress urinary incontinence. Russian Bulletin of the Obstetrician-Gynecologist. 2021; 21(3): 74–8. (in Russian) DOI 10.17116/rosakush20212103174

15. Silayeva E.A., Timoshkova Yu.L., Atayants K.M., Kurmanbaev T.E. et al. Epidemiology and risk factors for pelvic organ prolapse. Izvestia of the Russian Military Medical Academy. 2020; 39(S3-1): 161–3. (in Russian)

16. Tarabanova O.V., Melkoniants T.G., Ordokova A.A., Sokolova E.I. et al. Mesh-related complications after implantation of synthetic meshes using trocar and anchoring systems. Kuban Scientific Medical Bulletin. 2018; 25(1): 34–9. (in Russian)

17. Lee W., Tam J., Kobashi K. Surgery for apical vaginal prolapse after hysterectomy: abdominal sacrocolpopexy. Urol. Clin. North Am. 2019; 46(1): 113–21. DOI: 10.1016/j.ucl.2018.08.006

18. Glazener C., Breeman S., Elders A., Hemming C. et al. Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT). BJOG. 2020; 127(8): 1002–13. DOI: 10.1111/1471-0528.16197

19. Mereu L., Tateo S., D'Alterio M.N., Russo E. et al. Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 244: 16–20. DOI: 10.1016/j.ejogrb.2019.10.026

20. Tagliaferri V., Ruggieri S., Taccaliti C., Gentile C. et al. Comparison of absorbable and permanent sutures for laparoscopic sacrocervicopexy: a randomized controlled trial. Acta Obstet. Gynecol. Scand. 2021; 100(2): 347–52. DOI: 10.1111/aogs.13997

21. Bump R.C., Mattiasson A., Bø K., Brubaker L.P. et al. The standartization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am. J. Obstet. Gynecol. 1996; 175(1): 10–17. DOI: 10.1016/s0002-9378(96)70243-0

22. Korshunov M.Yu., Sazykina E.I. 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 Russian)

23. da Silveira S.D.R.B., Auge A.P., Jarmy-Dibella Z.I., Margarido P.F. et al. A multicenter, randomized trial comparing pelvic organ prolapse surgical treatment with native tissue and synthetic mesh: a 5-year follow-up study. Neurourol. Urodyn, 2020; 39(3): 1002–11. DOI: 10.1002/nau.24323

24. Dologaeva M.S., Totkar L.R., Orazov M.R., Aryutin D.G. et al. Morphology of the levator ani in patients with genital prolaps. Doctor Ru. 2020; 19(6): 70–8. (in Russian) DOI: 10.31550/1727-2378-2020-19-6-70-78