The absence of rigid fixation point, tissue atrophy and multi-compartment defects make post-hysterectomy vaginal vault prolapse a real challenge for the surgeon. The gold standard for treatment of post-hysterectomy vaginal vault prolapse is sacrocolpopexy. Unfortunately, this approach does not allow to perform reliable long-term meshless reconstruction in the anterior and posterior compartments. Moreover, the use of a mesh is associated with the risk of erosion. Aim to show the possibility of replacing a standard mesh with a vaginal flap during laparoscopic sacrocolpopexy. A 60-year-old patient with post-hysterectomy prolapse stage III underwent meshless laparoscopic vaginal-assisted sacrocolpopexy. The duration of the surgery was 105 min (35 min vaginal part and 70 min LS part). Intraoperative blood loss was 55 ml. No intraoperative and early postoperative complications were recorded. According to the ultrasound postvoiding residual was 35 ml, hematomas in the operation area were not visualized. During the exam in 12 months after the surgery, no signs of POP (Aa -2 Ba -3 C -8 Ap -3 Bp -3 tvl 9 gh 4 pb 3), erosion and any pain were detected. The results of the questionnaires were as follows: PFDI-20 22,92, PISQ-12 31 and ICIQ-SF 1. According to ultrasound the volume of residual urine was 0 ml. This approach allows to eliminate completely the risk of erosion and create a unified plastic natural construction from the vaginal cuff and tailored flap.
The use of synthetic implants in stress urinary incontinence and pelvic prolapse surgery is being actively debated today, not only among experts in the field but also in the media, the patient community, and even in legal and political set. Such response has had a natural effect on the clinical application of the technology. An absurd situation is observed in some countries: the bans imposed by the authorities have directly or indirectly restricted patients' access to the most sophisticated technologies with proven efficacy. This literature review aims to systematize the perspectives of the scientific and regulatory communities in leading countries on the use of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic prolapse.
Introduction. Vesicovaginal fistula (VVF) is a pathological communication between the urinary bladder and the vagina. The lack of common approaches to the treatment choice, its timing and postoperative management of patients makes this disorder one of the challenges of modern urogynecology. Materials and methods. Relevant publications were searched using the PubMed database, the Google Scholar search system, and the scientific electronic library eLibrary.ru. Results. VVF is the most common form of urogenital fistulas. In developed countries, the formation of VVF mainly are the result of surgical trauma or radiation therapy, but in developing ones the majority of VVF have an obstetric etiology. There are different classifications of VVF; however, there is no overall accepted one that is suitable for predicting treatment efficacy and long-term outcomes regardless of etiology of VVF. Treatment of VVF with long-term bladder drainage should be performed only for small, benign and unformed VVF. Surgical closure of VVF is the primary method of treatment. Surgery can be performed using abdominal and vaginal access. Regardless of the access, a positive result (closure of the fistula) on average is achieved in 90,8% of cases. The treatment of post-radiation fistulas is more challenged and associated with a high failure rate. Conclusion. Despite of the variety of VVF treatment options, unfortunately, there is no the perfect one yet due to the variability of VVF ethiology, the lack of unified curative approaches and the shortage of studies comparing different therapies.
Aim: to evaluate efficacy of plasmapheresis combined with low molecular weight heparins (LMWH) and acetylsalicylic acid (ASA).Materials and Methods. 327 plasmapheresis sessions were performed for 75 patients: 17 (22.6 %) patients during preparation for pregnancy, 11 (19.0 %) pregnant women in the first trimester, 33 (56.9 %) pregnant women in the second trimester, and 34 (58.6 %) pregnant women in the third trimester. Study inclusion criteria were as follows: high titers of antiphospholipid antibodies (APA) as well as included non-inclusion criteria in pregnant women with miscarriages and unfavorable anamnestic pregnancy outcome. 36 (62.1 %) women had pregnancy loss in anamnesis. All patients received low-dose ASA and LMWH therapy; 15 (25.86 %) pregnant women also received courses of intravenous immunoglobulins in the first and second trimesters.Results. 47 pregnant women had delivery, whereas 10 of women had pregnancy in progress. Term delivery was in 40 (85.1 %) patients, so that 23 (48.9 %) pregnant women had delivery per vias naturales. The average weight of the fetus was 3364.00 ± 393.76 g, height - 52.13 ± 1.82 cm. In 100 % cases, Apgar score was 8 points. 24 (51.1%) pregnant women had delivery via cesarean section. The average blood loss comprised 528.64 ± 166.10 ml. The average fetal weight in group after surgical delivery was 2982.14 ± 582.88 g, average height - 49.14 ± 4.09 cm, the Apgar score - 7.69 ± 0.47 points. Preterm births were observed in 7 (14.9%) cases, all via cesarean section. In 1 case, early fetal death was at gestational age of 8/9 weeks; according to the karyotyping data, a fetal chromosomal abnormality was detected. No severe obstetric complications were observed.Conclusions. Combining plasmapheresis with low dose LMWH and ASA therapy demonstrated high efficacy in treating obstetric APS manifested as high percentage of favorable pregnancy outcomes and low number of obstetric complications.
Introduction. The amount of non-absorbable synthetic material used in the surgical treatment of pelvic organ prolapse and stress urinary incontinence has been shown to directly correlate with the risks of mesh-associated complications. Previously, we developed a partially absorbable implant. Currently, there are insufficient data on the use of partially absorbable implants in female pelvic floor reconstruction, which requires comparative biomechanical and pathomorphological studies.Objective. To compare the biomechanical properties of a new generation partially absorbable implants and nonabsorbable polypropylene mesh implants during animal model.Materials & methods. Thirty-nine rabbits weighing 3200 ± 250 g were randomised into three groups depending on the implanted endoprosthesis: group 1 (n = 15) — “Axilen” implant (polydioxanone 98%, polypropylene 2%), group 2 (n = 15) — “Axilen Rapid” implant (polyglycapron 98%, polypropylene 2%), group 3 (n = 9) — “Urosling 1” implant. After implantation, rabbits of all 3 groups were divided into 3 subgroups according to the withdrawal period from the experiment: 14 days, 60 days, and 180 days. The biomaterial obtained was subjected to two studies: evaluation of the macroscopic view of the explanted mesh endoprosthesis with the formed capsule and the surrounding tissues, study of the biomechanical properties of the formed connective tissue capsule with the implant.Results. According to macroscopic evaluation, there was a less significant tissue reaction to partially absorbed implants. A comparative analysis of biomechanical indices revealed no statistically significant difference in rupture elongation at all follow-up periods among the presented groups. Tensile strength, at 60 and 180 days, was not statistically different between the groups described. At 14 days, there was a statistically significant difference in tensile strength between groups 1 and 3 (p = 0.003).Conclusion. During biomechanical animal experiments, the connective tissue capsule formed on the partially absorbable implant was not inferior to the similar parameter of the non-absorbable sample in its tensile strength, which explains a great potential for the use of partially absorbable implants in reconstructive surgery of pelvic organ prolapse and stress urinary incontinence.
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