© Borgis - New Medicine 4/2012, s. 125-128
*Agnieszka Ledniowska1, Grzegorz Ledniowski2, Jarosław Karoń1, Przemysław Karoń1
Implantation of the gynecare prolift system in lower pelvic organ prolapse correction in patients with co-occurring urological disorders
1Gynaecology-Maternity Ward, ZOZ Kędzierzyn-Koźle Public Hospital, Poland
Supervisor: Jarosław Karoń, MD
2Urology Ward, ZOZ Kędzierzyn-Koźle Public Hospital, Poland
Supervisor: Andrzej Trondowski
Aim. Assessment of the impact of correction of pelvic organ prolapse on co-occurring urological disorders in patients operated on with the use of the TVM Prolift system.
Material and methods. The TVM Prolift system was implanted in 22 patients with co-occurring pelvic organ prolapse in POPQ stages from II to IV and urological disorders such as: stress urinary incontinence, mixed urinary incontinence, overactive bladder, pollakiuria and difficulties with starting urination.
Results. In all of the patients, the surgery restored the correct anatomical conditions of the lower pelvic organs. In 77.3% of the patients operated on, the urological problems subsided or abated, in 4.5% of the patients the symptoms intensified and in 18.2% of the patients the symptoms in question remained unchanged.
Conclusions. It is justified to implant the TVM Prolift system in patients with co-occurring pelvic organ prolapse and urological disorders, because after the restoration of proper stability of lower pelvic organs the urological disorders subsided or abated in 77.3% of the patients operated on.
Pelvic organ prolapse (POP) is defined as the descent of lower pelvic organs, which leads to the lowering of the vaginal walls and/or uterus. The final stage of this process is the prolapse of the genital organ. The condition in question can be seen while supine; it usually worsens with the increase of intra-abdominal pressure. This defect often intensifies with consecutive births and the woman’s age (1, 2). According to different authors, the incidence of pelvis organ descent in the female population between 20 and 70 is about 14%. In nulliparous women, POP occurs in 2-4% of the population in multiparous women the incidence of such disorders reaches 76% (3, 4). It is believed that the cause of POP occurrence is the weakening of the pelvic floor muscles, inadequate quality of the connective tissue and failure of the musculo-fibrous apparatus of lower pelvic organs (5).
POP patients often also suffer from urological disorders resulting from abnormal anatomical conditions in the pelvic floor area (6). In order to determine patients in whom genital organ prolapse co-occurs with urological disorders, before any corrective surgeries are conducted, apart from the case history, physical examination and ultrasonographic examination, urodynamic testing needs to be performed.
A number of various POP corrective surgery methods have been developed. It is estimated that the lifetime risk of a surgery due to POP is 7-14% (7). One of the methods of restoration of proper anatomical conditions of lower pelvic organs is vaginal implantation of synthetic meshes (Gynecare Prolift) which take over the role of a deficient suspensory system of lower pelvic organs. The application of synthetic materials significantly improves subsequent results of surgery, thus considerably increasing the comfort of patients’ lives (7). Implantation of the TVM Prolift system enables simultaneous improvement of anatomical conditions of lower pelvic organs as well as resolution of urological disorders in a large number of patients (8).
The evaluation of the results of surgery with the application of the Gynecare Prolift system in instances of urological disorders.
MATERIAL AND METHODS
The Gynecare Prolift system was implemented in 22 patients between 33 and 77 in whom pelvic organ prolapse had co-occurred with urological disorders. The patients were operated on at the Kędzierzyn-Koźle ZOZ Public Hospital between October of 2006 and December of 2008.
In the patients, pelvic organ prolapse disorders in stages from II to IV, according to POP-Q classification, co-occurred with urological disorders in the form of: stress urinary incontinence in10 patients, mixed urinary incontinence in 7 patients, in 2 patients overactive bladder was diagnosed, in 2 pollakiuria occurred, 1 patient reported problems with starting urination.
All of the patients were called in for check-ups consisting of physical examination and urodynamic testing. They also filled out anonymous questionnaires, subjectively evaluating their disorders. The patients answered the questions:
1. Did the surgery conducted affect preoperative urological disorders? (a. yes; b. no).
2. If the surgery did affect the disorders, what was the result? (a. resolution of the preoperative symptoms; b. reduction of the preoperative symptoms; c. intensification of the preoperative symptoms).
The application of the TVM Prolift system restored normal anatomical conditions of the genital tract in all of the patients.
Among 22 patients reporting urological problems prior to the surgery, the operation caused:
1. In 15 patients (68.2% of the population) resolution of the symptoms.
2. In 2 patients (9.1% of the population) reduction of the symptoms.
3. In 4 patients (18.2% of the population) the symptoms remained unchanged.
4. In 1 patient (4.5% of the population) the symptoms intensified.
After analysing the population with respect to urological disorders, it was found:
A. In the group of patients with stress urinary incontinence (10 patients):
1. The surgery did not affect urinary continence: 3 patients (30%).
2. The surgery caused intensification of the symptoms: 1 patient (10%).
3. The surgery caused reduction of the symptoms: 2 patients (20%).
4. The surgery caused resolution of the symptoms: 4 patients (40%).
B. In the group of patients with mixed urinary incontinence (7 patients):
1. The surgery did not affect urinary continence: 1 patient (14.3%).
2. The surgery caused resolution of the symptoms: 6 patients (85.7%).
C. In the group of patients with an overactive bladder (2 patients):
a. The surgery caused resolution of the symptoms: 2 patients (100%).
D. In the remaining patients (3 patients) :
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