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

Abstract

Aim: a comparative analysis of the results of laparoscopic sacrocolpopexy, sacro-spinous fixation and the developed new method of surgical correction of pelvic organ prolapse after hysterectomy. Materials and methods: The prospective non-randomized study included 57 patients with symptomatic post-hysterectomy prolapse of the pelvic organs of stage II, III, IV, who applied to the Сlinical Hospital «RZD-Medicine» Tula in the period from August 2019 to September 2023 The main group (n=18) consisted of women who underwent surgical correction of post -hysterectomy pelvic organ prolapse in a newly developed way; the second group (n=19) consisted of women who underwent laparoscopic promontofixation according to the classical technique; patients of the third group (n=20) underwent installation of an apical sling using a UroSling-1 mesh endoprosthesis (Lintex LLC, St. Petersburg). The quality of life of the patients was assessed using specialized validated questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7). Patients were asked to fill out questionnaires before surgery, as well as 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 2nd group significantly exceeds the indicators of the 1 and 3 groups. The average length of hospital stay in patients of the 1st group was 4,4 ± 0.6 (95% CI 4,1 – 4,7) bed days, the 2nd – 4,9 ± 1,1 (95% CI 4,6 – 5,3), the 3rd – 4,6 ± 0,6 (95% CI 4,3 – 4,9), differences were statistically insignificant (p1-2 = 0,437, p1-3 = 0,137, p2-3 = 0,235). Anatomical results after 24 months at points Aa and Ba showed statistically significant differences. At point Aa, p1-3=0,007, p2-3=0,004, at point Ba, p1-3=0,032, p2-3=0,041. A comparative assessment of the questionnaire data before surgery 12 and 24 months after surgery showed a significant improvement in the quality of life of patients in three groups. Conclusion: The proposed method of correction of post-hysterectomy pelvic organ prolapse provides high anatomical and functional results, and also reduces the likelihood of repeated surgical intervention for recurrence.