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Journal of Education, Health and Sport

Modern approaches to the treatment of genital prolapse in obese women
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Modern approaches to the treatment of genital prolapse in obese women

Authors

  • R. Safonov Kharkiv National Medical University
  • V. Lazurenko Kharkiv National Medical University
  • O. Lyashchenko Kharkiv National Medical University
  • I. Afanasyev Kharkiv National Medical University
  • K. Garkavenko Kharkiv Regional Perinatal Center
  • O. Chernyak V. N. Karazin Kharkiv National University

DOI:

https://doi.org/10.12775/JEHS.2021.11.07.031

Keywords

genital prolapse, obesity and overweight, polypropylene mesh , quality of life

Abstract

Introduction. The problem of female genital prolapse (GP) remains in the sportlight of gynecologists, because despite the variety of surgical methods, there are still recurrences of the disease, which are associated not only with the failure of the restored ligaments, fascia, muscles, damaged pelvic floor and perineum, but with the imperfection of the operation. The solution of this problem is especially important in the treatment of patients with extragenital pathology, in particular obesity. The purpose: to optimize the treatment of genital prolapse in obese patients by determining an individual approach to planning surgical treatment taking into account the degree of obesity and concomitant pathology. Materials and methods. We examined 65 patients of which 20 had genital prolapse and obesity (main group), 25 had genital prolapse and normal weight (comparison group), 20 women did not have gynecological diseases and extragenital pathology made up control group. To diagnose obesity and determine its degree we calculated body mass index (BMI). To determine the degree of GP its quantitative assessment was used (POP-Q; 1996). Surgical intervention included transvaginal extirpation of the uterus without appendages, anterior colporrhaphy, colpoperineoraphy with levatoplasty, sacrospinal colpopexy. Transabdominal and laparoscopic colposacropexy in obese women were not used due to the presence of relative contraindications for laparoscopy (cardiovascular disease, respiratory pathology, adhesions, the condition after hernias’ surgery). Therefore, all operations on women with GP and obesity were performed transvaginally due to the inability to perform abdominal access. In comparison group transvaginal surgery was performed. All the groups under study were representative. Before the use of polypropylene mesh "Polymesh" to minimize purulent-septic complications associated with the use of synthetic prostheses aquadissection was performed with 0.9% saline with the addition of 1 g of ceftriaxone per 200 ml. After the operation, the women used suppositories with hyaluronic acid (revitax). Results. The results of surgical treatment have been analyzed and the following data were obtained: recurrences in the main and in the comparison group were 4% (2 women in whom operations were performed with the use of their own tissues without  mesh prosthesis). Infectious complications, dyspareunia and pelvic pain were not observed. Conclusions. Surgical treatment of GP in obese women by using polypropylene mesh "Polymesh" for colposacropexy after transvaginal uterine extirpation increases the effectiveness of treatment  and redduces the number of recurrences. Hydropreparation of the mesh with an antibacterial agent and postoperative use of hyaluronidase intravaginally helps to reduce purulent-septic complications of surgery and improves the patients’quality of life.

References

Fleischer K, Thiagamoorthy G. Pelvic organ prolapse management. Post Reproductive Health. 2020;26(2):79-85.

Surgery for women with pelvic organ prolapse with or without stress urinary incontinence /Kaven Baessler, Corina Christmann-Scmid, Christipher Maher. 19 augeust 2018 Cochrane Database /httpc://doi.org/ 10.1002/ 14651858. CD013108

Kozak HI, Marushchak MI Prevalence of alimentary obesity and factors contributing to its development. Nursing 2013; 3: 27-29 [ in Ukrainian].

Lee UJ, Kerkhof MH, Van Leijsen SA, Heesakkers JP. Obesity and pelvic organ prolapse. Curr Opin Urol 2017;27(5):428-434.

Shkarupa DD, Kubin ND, Popov EN And, Shapovalova EA, Kovalev GV. Anterior-apical prosthetic reconstruction of the pelvic floor by vaginal access with the use of ultralight mesh implant 2 years of observation. Journal of Obstetrics and Gynecology. 2018; 67 (3): 55-63 [in Russian].

Gromyko NL Experience in the use of mesh prostheses in the correction of pelvic prolapse. Reproductive health. Eastern Europe = Reproductive health. Eastern Europe: an international scientific and practical journal. 2017; 7 (3): 437-439. [ in Russian].

Chughtal B, Mao J, Buck J, Raplan S, Sedrakyan A. Use and risks of surgical mesh for pelvic organ prolapse surgery in women in New York state: population based cohort study. BMJ. 2015; 350: h2685. Epub 2015 Jun 2.

Davidson ERW , Thomas TN, Lampert EL, Paraiso MFR, Ferrando CA. Route of hysterectomy during minimally invasive sacrocolpopexy does not affect postoperative outcomes. International Urogynecology Journal. 2019; 30(4): 649-655.

Safonov RA, Lazurenko VV, Chernyak OL, Lyashchenko OA, Ovcharenko OB. Prevention of recurrence of genital prolapse in elderly women after surgery. Reproductive endocrinology. 2020; 4 (54): 95-98 [in Ukrainian].

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Published

2021-07-29

How to Cite

1.
SAFONOV, R., LAZURENKO, V., LYASHCHENKO, O., AFANASYEV, I., GARKAVENKO, K. and CHERNYAK, O. Modern approaches to the treatment of genital prolapse in obese women. Journal of Education, Health and Sport. Online. 29 July 2021. Vol. 11, no. 7, pp. 324-334. [Accessed 28 June 2025]. DOI 10.12775/JEHS.2021.11.07.031.
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Issue

Vol. 11 No. 7 (2021)

Section

Research Articles

License

Copyright (c) 2021 R. Safonov, V. Lazurenko, O. Lyashchenko, I. Afanasyev, K. Garkavenko, O. Chernyak

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0

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