The role of multiparametric ultrasonography in verifying the status of mesh implants after surgical treatment of genital prolapse

Abstract

Genital prolapse (GP) remains a common pathology that significantly impairs the quality of life in women. Among modern surgical methods for correcting apical descent, laparoscopic sacrocolpopexy (SCP) and laparoscopic pectopexy (PP) hold leading positions. SCP is associated with certain risks, including damage to presacral vessels, chronic constipation, and osteomyelitis. Pectopexy serves as an innovative alternative involving the fixation of a mesh implant to the iliopectineal (pectineal) ligaments. This approach avoids the critical areas of the promontory and reduces the frequency of complications. Objective assessment of the mesh implant’s condition post-surgery using the traditional POP-Q clinical examination is limited, as it does not provide data regarding the position, integrity, tension, or interaction of the prosthesis with surrounding tissues. In this context, multiparametric ultrasonography (transperineal ultrasound with 3D/4D reconstruction) becomes crucial as a real-time imaging method, particularly during the Valsalva maneuver.

Aim - вased on clinical case analysis, to determine key ultrasound features of mesh implant positioning following reconstructive surgery for pelvic organ prolapse.

Based on the analysis of original clinical observations, key ultrasound criteria for the normal state of a mesh implant after laparoscopic PP were identified. These include: assessment of the distance from the lower edge of the mesh to the ureterovesical segment, and implant integrity - specifically the absence of twisting, fragmentation, or ruptures of the hyperechoic mesh line (in B-mode and 3D reconstruction). Postoperative follow-up intervals for patients were proposed, including re-examination at one week, one month, and six months after treatment.

Conclusions. Ultrasound criteria for the «normal» visualization of the postoperative state after PP have been established. The introduction of multiparametric ultrasound into the routine practice of postoperative monitoring of patients after laparoscopic PP will allow to improve the quality of dynamic control, timely detect subclinical complications and optimize patient management tactics.

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 participating institution. The informed consent of the patients was obtained for conducting the studies.

No conflict of interest was declared by the authors.