Surgical treatment of stress urinary incontinence and severe pelvic organ relaxation in the medically compromised elderly patient using local anesthesia

Background . The treatment of genital prolapse is exclusively surgical, usually approached from the perineal area. If surgery is not recommended, the solution can be conservative palliative. Method . This paper is based on scholarly medical articles and the expertise of Bucur Clinic of Obsetrics and Gynecology, between January 2010 and December 2016, in relation with modern surgical treatments of genital prolapse, using synthetic mesh. Results . Between January 2010 and December 2017, at the Bucur Clinic of Obstetrics and Ginecology, there were 320 patients surgically treated for urogenital affections. There were registered 53 cases of first- and second-degree genital prolaps, and 65 cases of third-degree genital prolaps. A number of 98 patients presented cystorectocele, of which 82 associated with stress urinary incontinence and only 40 with uterine prolaps. There were made 67 direct cystopexies with polypropylene allograft by the transobturator midurethral slings procedure (TOT). Also, the Kelly technique was systematically applied for the surgical management of stress urinary incontinence (SUI). The isolated SUI cases have been treated by the aplications of a suburethral sling, again using the TOT technique(61). The surgical treatment for posterior vaginal wall defect usually consisted in posterior colporrhaphy with perineorrhaphy(73). In cases associated with important uterine descensus, the standard technique consisted in hysterosacropexy with or without reinforcement of the rectovaginal fascia with synthetic mesh (3/14). A total of 7 colpocleisis have been recorded exclusively in elderly patients with associated biological conditions, for which extensive surgery was not recommended. Discussion . Petros and Ulmstem’s integral theory, which was developed in the ’90s, states that pelvic-genital static disorders and those of urinary incontinence come from the alteration of fascial and ligamentary structures that are part of the pelvian diaphragm. This theory led to the development of vaginal and endoscopic surgical tehniques using syntetic allograft. After a period of prolonged use because of its superior efficiency on a long term, the indications of synthetic allografts have been reduced and they are reserved now for patients with large defects of pelvine statics, for recurrent cases or for women in perimenopause. An important criterion in the surgical choise is the conservation of sexual function. Conclusions . It is recommended to use the surgical correction of prolapse using synthetic mesh only in case of failure of a first surgery, or if there are known risk factors for the recurrence of prolapse.

Download Full-text

DIAGNOSIS AND EVALUATION OF CRITERIA FOR CONDUCTING SURGICAL TREATMENT IN WOMEN WITH CYSTOCELE AND STRESS URINARY INCONTINENCE

Modern medical technologies ◽

10.34287/mmt.1(48).2021.8 ◽

2021 ◽

Vol 48 (1) ◽

Author(s):

О. O. Lyulko ◽

O. O. Burnaz ◽

I. N. Nikitiuk ◽

О. S. Sagan ◽

M. V. Varvashehia

Keyword(s):

Urinary Incontinence ◽

Surgical Treatment ◽

Stress Urinary Incontinence ◽

Operative Treatment ◽

Pelvic Organ ◽

Control Group ◽

Pelvic Prolapse ◽

Absolute Criterion ◽

Type 3 ◽

The Impact

Abstract Purpose of the study. Clarification of absolute and relative criteria for the surgical treatment of pelvic pelvic prolapse (PMT) and stress urinary incontinence (SNA). Materials and methods. A survey was conducted on 85 patients in whom OST and SNA were detected. The women were divided into groups according to the stage of POMT and SNM: 2nd group – 32 patients with PIDs of stages I and II and SNM 2a, 2b types of lung and moderate severity; Group 3 (main) - 53 patients with MIDI III and IV stages and MSM type 3 moderate and severe severity. This group of patients subsequently undergone operative treatment according to the patent for utility model No. 109201. The main group (3rd group) included: 3a group – 28 women from the OMT III and IV stages and SNM 3rd type of medium and severe severity without delay in urination; 3b group – 25 women with STI III and IV stages and SNM of type 3 of moderate and severe degree of severity with delay of urination (chronic or acute). 15 women were examined without complaints, who entered the control group (1st group). Results. According to the results of the study, it was recorded that, regardless of the stage of the PMS and SNM, even their minimal manifestations significantly reduced the quality of life of patients (by 64%) due to the impact on the physical, but to a greater extent, on the psychological components of health. Conclusion. The absolute criterion for operative treatment is a set of prolapse of the pelvic organs (PMTCT), urinary incontinence, vesicularization of the bladder type 2a and above, an increase in the posterior urethro-vascular angle of more than 114 °. Treatment of stress urinary incontinence on the background of OST should necessarily include fixation of the uterine ligation apparatus and surgery on the Berch in connection with significant deformation of the bladder neck. Keywords: pelvic organ prolapse, urinary incontinence, methods of diagnostics.

Download Full-text

Improvement in the quality of life in women with stress urinary incontinence after surgery for pelvic organ prolapse

Medicinski pregled ◽

10.2298/mpns1908197m ◽

2019 ◽

Vol 72 (7-8) ◽

pp. 197-201

Author(s):

Ljiljana Mladenovic-Segedi

Keyword(s):

Quality Of Life ◽

Urinary Incontinence ◽

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Urge Urinary Incontinence ◽

Pelvic Organ ◽

Posterior Colporrhaphy ◽

Average Value

Introduction. Pelvic organ prolapse is commonly associated with symptomatic stress urinary incontinence, in up to 50% of patients. The aim of our research was to examine the quality of life of women with urinary incontinence and pelvic organ prolapse after conventional surgical treatment. Material and Methods. The research included 50 patients with stress urinary incontinence and pelvic organ prolapse that underwent vaginal hysterectomy with anterior and posterior colporrhaphy. The pelvic organ prolapse-quantification system was used to determine the degree of genital prolapse. All patients completed a questionnaire to determine the ?stress and urge? score preoperatively, as well as the Urinary Distress Inventory-6 and Urinary Impact Questionnaire-7 during the follow-up examination, a year after the surgery. Results. One year after surgery, 20 patients (40%) presented with a recurrence of cystocele. The average value of the Urinary Distress Inventory-6 questionnaire a year after surgery was 29.0 ? 10.8, while the average value of the Urinary Impact Questionnaire-7 questionnaire was 3.7 ? 16.3. After the surgery, 6 patients (12%) had persistent stress urinary incontinence and 4 patients (8%) had urge urinary incontinence. Among patients with persistent stress urinary incontinence, two patients reported pronounced symptoms of stress urinary incontinence and reoperation was performed. Conclusion. The classical surgical treatment of pelvic organ prolapse with anterior and posterior colporrhaphy leads to improvement in the quality of life of patients with pelvic organ prolapse and stress urinary incontinence. If the symptoms of stress urinary incontinence persist after classical surgical treatment, other anti-incontinence surgical modalities should be considered.

Download Full-text