Результаты инструментальных исследований у пациенток с пролапсом гениталий и стрессовым недержанием мочи после хирургического лечения

Abstract

Мета дослідження: розробити, впровадити, оцінити можливість одночасної кольпопексії, кольпоррафії і операції з формуванням шийки сечового міхура лапароскопічно. Об’єкт і методи. Обстежено 85 жінок з пролапсом геніталій і стресовим нетриманням сечі. Висновки. Встановлено, що розроблена методика з використанням нерозмоктуючого матеріалу (катетера) для фіксації круглих зв’язок матки створює стабільну кольпопексію протягом мінімум 24 місяців. Одночасна кольпопексія і операція по Берча дозволяє, у пацієнток з пролапсом органів малого тазу 3 і 4 стадіями і стресовим нетриманням сечі 3 типу, відновити анатомічне положення матки і сечовипускання, сформувати шийку сечового міхура в 98% випадків.

Цель исследования: разработать, внедрить, оценить возможность одновременной кольпопексии, кольпоррафии и операции с формированием шейки мочевого пузыря лапароскопически. Объект и методы. Обследовано 85 женщин с пролапсом гениталий и стрессовым недержанием мочи. Выводы. Установлено, что разработанная методика с использованием нерассасывающегося материала (катетера) для фиксации круглых связок матки создает стабильную кольпопексию в течение минимум 24 месяцев. Одновременная кольпопексия и операция по Берчу позволяет, у пациенток с пролапсом органов малого таза 3 и 4 стадиями и стрессовым недержанием мочи 3 типа, восстановить анатомическое положение матки и мочеиспускание, сформировать шейку мочевого пузыря в 98% случаев.

The aim of the study was to develop, implement, evaluate the possibility of simultaneous colposypia, colpraphhya and operations with the formation of the neck of bladder laparoscopically. Object and methods. 85 women with prolapse of pelvic organs (POP) and stress urinary incontinence (SUI) were examined. They were divided into the following groups: the 2nd group – 32 patients with POMT 1 and 2 stages of severity and SUI 2a, 2b types, mild and moderate severity; 3rd group (main group) – 53 patients with POP 3 and 4 stages and type 3 SUI, medium and severe severity. The main group (surgical treatment according to the patent for utility model № 109201) included: 3a group-28 women with POP 3 and 4 stages and with SUI 3 type, moderate and severe severity, without delay of urination; 3b group-25 women with POP 3 and 4 stages and with sui 3 type, moderate and severe severity, with delay of urination (chronic or acute). The control group (group 1) consisted of 15 women without urologic and gynecological pathology. Methods: clinical-anamnestic, instrumental, statistical. Ultrasound was performed with the help of a vaginal sensor, the length of the urethra was determined, its inner and outer diameter in the proximal part, posterior urethro-vesic and pubo-urethral angles, active (for the Valsalva test) and passive dislocations of the urethro-vesic segment according to the pubic bone. Cystography was performed in 4 projections: lying at rest, lying with straining, lying under 45° at rest, standing with straining. This study was conducted to determine the shape, size, position of the bladder and urethra according to the pelvic bones. The functional state of urine-excretory system was determined using uroflowmetry. All patients underwent cystoscopy. During cystoscopy, the mucosa of the bladder was evaluated, the presence of vesicalization, urethral enlargement, deformation of the walls of the bladder. Results. In whole 62 patients had the surgical treatment. Surgical intervention is done to strengthen the ligamentous apparatus and to correct the anatomical position of the bladder neck in patients with POP and SUI. All patients were monitored right after the operation, at 1, 3, 6, 12 and 24 months after surgical intervention. According to the diagnostics after operation 98% had high effect in treatment of POP and SUI. One patient (2%) had relapse after 3 months of postoperative period because she did not follow the recomendations. She passed again the surgical treatment and was under control for 24 months. She got high effect results. Conclusions. It has been established that the developed technique with the use of a non-absorbable material (catheter) to fix the round ligament of the uterus creates stable colpopexy for a minimum for 24 months. Simultaneous colpopexy and Birch surgery allows, in patients with pelvic organ prolapse 3 and 4 stages and stress urinary incontinence of 3 type, to restore the anatomical position of the uterus and urination, to form the neck of bladder in 98% of cases.