Comparative effectiveness of surgical treatment methods of genital prolapses combined with uterine leiomyoma

Abstract

Uterine leiomyoma is combined with genital prolapse in approximately 20% of cases and is probably a risk factor for the latter. Until now, no differentiated approach to the choice of the surgical intervention method of genital prolapses combined with uterine leiomyoma has been developed, depending on the type of prolapse and prolapse of the internal genital organs.

Purpose - to evaluate the effectiveness of different operative treatment complex uterine leiomyoma with genital prolapse depending on the type of pelvic organ prolapse.

Materials and methods. 80 patients with genital prolapse combined with uterine leiomyoma aged from 34 to 67 years (on average - 50.34±9.46 years) were examined. Depending on the type of the surgical intervention performed, the women were divided into two groups, in each group two subgroups were distinguished regarding the type of genital prolapse. The Group I consisted of 40 women who underwent amputation or extirpation of the uterus and correction of genital prolapse using a mesh implant by the pectopexy method, in the Group II (n=40) - similar operations with prolapse correction were performed by using method of lateral fixation. Ia (n=18) and IIa (n=20) subgroups included patients with cystocele, and Ib (n=22) and IIb (n=20) subgroups comprised of patients with cystocele and/or apical prolapse. To assess the quality of the treatment results, a bimanual examination with a cough test and a Valsalva maneuver, a 2-hour pad test, as well as surveys using the PFDI-20 and PISQ questionnaires were used. Data analysis was carried out using The Statistical Package for Social Sciences (SPSS), version 20.0.

Results. According to the PEDI-20 questionnaire, the frequency of pelvic function improvement (an increase of ≥60 points) 6 months after surgery was significantly higher among women of the Ib than Ia subgroup (OR=4.4; 95% CI: 1.13-17.07) and in IIa comparing to IIb subgroup (OR=10.52; 95% CI: 2.27-48.75). Improvement of sexual function (PISQ score from 21 to 30 points) and good/excellent result (PISQ score - >30 points) 6 months after surgery had significantly more patients in the Ib than in the Ia subgroup (OR=7.5; 95% CI: 1.28-44.08) and in IIa comparing to the IIb subgroup (OR=31.2; 95% CI: 3.29-295.3).

Conclusions. The highest percentage of positive results of genital prolapse correction by pectopexy was in patients with cystocele and/or apical prolapse, and in the group of prolapse correction by lateral fixation - in patients with cystocele.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.