I.I. MUSIN¹, R.A. NAFTULOVICH¹, D.F. ABSALYAMOV², L.V. LUZINA³, E.M. POPOVA¹, D.V. ALTYNOV³, A.R. MOLOKANOVA¹, K.N. YASHCHUK¹

¹Bashkir State Medical University, Ufa,

²City Clinical Hospital of Demskiy district of Ufa, Ufa

³City Clinical Hospital No. 18, Ufa

Contact:

Musin I.I. ― PhD (medicine), Associate Professor of the Department of Obstetrics and Gynecology

Address: 3 Lenin str., 450008 Ufa, Russian Federation, tel. +7-917-467-10-64, e-mail: ilnur-musin@yandex.ru

Objective. To identify additional risk factors for the development of relapse and complications of genital prolapse.

Material and methods. 65 women with a diagnosis of POP-Q stage III-IV were examined, of which 21 patients were diagnosed with post-hysterectomy prolapse. Based on LDF-metry, the control group included 76 women without violation of the pelvic organs anatomy, with no history of pregnancy and childbirth. In a comprehensive study, we assessed blood flow in the vaginal tissues using the LDF method. All patients underwent a biopsy of the cardinal and sacrouterine ligaments. A morphometric analysis of biopsy samples was carried out, including analysis of sections using the Axiovision program (C. Zeis, Germany).

Results. All patients of the main group underwent traditional transvaginal hysterectomy with reconstruction of the pelvic floor. On the day of hospitalization in this group, the length of the vagina and LDF-metry were measured. After vaginal surgery, the vaginal length was shortened by 4 cm (TVL). That was probably due to suturing of the vaginal stump, resection of the vaginal mucosa and reduction of m.levatorani. With post hysterectomy prolapse, the condition of the vaginal wall is of particular importance, which is an important point when choosing a mesh prosthesis and surgical access. Before surgery, all patients with relapse underwent LDF-metry. With POP-Q stage IV, the minimum values ​​of tissue dopplerometry from the posterior vaginal wall were diagnosed. Based on the analysis of the blood circulation state (LDF-metry) and the length of the vagina, the following operations were performed: sacrospinal fixation, Lephor–Neugebauer colporography, sacrocolpopexy, aponeurotic fixation with preliminary reinforcement and sacrocolpopexy using an anchor.

Conclusion. When choosing a surgical intervention, surgeons should be guided by not only the prolapse stage, but also take into account the length of the vagina and the degree of blood flow disturbance in the walls of the vagina, which will reduce the risks of complications and relapse.

Key words: genital prolapse, laser Doppler flowmetry, pelvic organ prolapse.

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