M.R. ORAZOV¹, V.E. RADZINSKIY¹, F.F. MINNULLINA²

 ¹Peoples’ Friendship University of Russia, Moscow

²Kazan Federal University, Kazan

  Contact details:

Minnullina F.F. — PhD (Medicine), Assistant Professor, Head of the Department of Obstetrics and Gynecology, Institute for Fundamental Medicine and Biology

Address: 18 Kremlevskaya St., 420008 Kazan, Russian Federation, tel.: +7-987-233-04-78, e-mail: minnullina_f@mail.ru

Pelvic organ prolapse (POP) is a prolapse of the pelvic organs as a result of a weakening of the pelvic floor supporting system. To denote prolapse of the anterior vaginal wall, the term «cystocele» is used, of the posterior wall — «rectocele», while the lowering of the arch / stump of the vagina or cervix is called «apical prolapse». There is also a «total prolapse» — a recurrence of the pathological process with all three sectors involved, and the uterus extending beyond the genital fissure. The genitals involved in the pathological process determine the POP clinical picture; 2/3 of women show signs of two or three sectors involved in the process at the same time.

In general, surgical procedures are effective in relieving the POP symptoms, preventing the disease progression and improving quality of life. However, the short- and medium-term results of surgical treatment are not always satisfactory. The recurrence rate of POP after surgical treatment is high, and the need for repeated surgery is approaching 30%.

The purpose is to analyze and summarize the current scientific data on the POP clinical phenotypes. We analyzed 2014–2024 scientific publications in the PubMed, eLibrary, CochraneLibrary, and Science Direct databases using the keywords: pelvic organ prolapse, cystocele, rectocele, and apical prolapse.

Conclusions. Based on the literature analysis, we conclude that to date there is no understanding of the mechanics of the POP formation in different parts of the pelvis, the interaction of prolapses of the contralateral sections. There is no unified approach among specialists to the treatment of patients with POP, and indications for surgical intervention are not unified. This determines the importance of studying different clinical phenotypes of POP, their relationship and interaction in a large sample.

Key words: pelvic organ prolapse, apical prolapse, rectocele, cystocele, enterocele, ureterocele, recurrence, surgical treatment.

REFERENCES

1. Klinicheskie rekomendatsii “Vypadenie zhenskikh polovykh organov” [Clinical guidelines «Prolapse of female genital organs»]. Moscow, 2024. P. 36.
2. Wu J.M., Vaughan C.P., Goode P.S. et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol, 2014, vol. 123 (1), pp. 141–148.
3. Doo J., Khandalavala J. Procidentia. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
4. Weintraub A.Y., Glinter H., Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int. Braz. J. Urol, 2020, vol. 46 (1), pp. 5–14.
5. Hendrix S.L., Clark A., Nygaard I. et al. Pelvic organ prolapse in the Womens Health Initiative: gravity and gravidity. Am. J. Obstet. Gynecol, 2002, vol. 186 (6), pp. 1160–1166.
6. Olsen A.L., Smith V.J., Bergstrom J.O. et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet. Gynecol, 1997, vol. 89 (4), pp. 501–506.
7. Barber M.D., Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int. Urogynecol. J, 2013, vol. 24 (11), pp. 1783–1790.
8. Aigmueller T., Dungl A., Hinterholzer S., Geiss I., Riss P. An estimation of the frequency of surgery for posthysterectomy vault prolapse. Int. Urogynecol. J, 2010, vol. 21 (3), pp. 299–302.
9. Smith F.J., Holman C.D., Moorin R.E., Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet. Gynecol, 2010, vol. 116 (5), pp. 1096–1100.
10. Gvozdev M.Yu., Tupikina N.V., Kasyan G.R., Pushkar’ D.Yu. Metodicheskie rekomendatsii no. 3 “Prolaps tazovykh organov v klinicheskoy praktike vracha-urologa” [Guidelines No. 3 «Pelvic organ prolapse in the clinical practice of a urologist»]. Moscow, 2016. P. 52 (available at: https://uroweb.ru/sites/default/files/pto.pdf)
11. Arellano M., Santis-Moya F., Maluenda A. et al. Prevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service. Rev. Bras. Ginecol. Obstet, 2024, vol. 46. e-rbgo10.
12. Makajeva J., Watters C., Safioleas P. Cystocele. 2022 Oct 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
13. Laktionova M. V., Korkan A. I. New concept of using synthetic prosthetic material in genital prolapse surgery. Vestnik AGIUV, 2019, no. 1 (in Russ.), available at: https://cyberleninka.ru/article/n/novaya-kontseptsiya-primeneniya-sinteticheskogo-proteznogo-materiala-v-hirurgii-genitalnogo-prolapsa (accessed on: 18.09.2024).
14. Bordeianou L.G., Anger J.T., Boutros M. et al. Members of the Pelvic Floor Disorders Consortium Working Groups on Patient-Reported Outcomes. Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Female Pelvic Med. Reconstr. Surg, 2020, vol. 26 (1), pp. 1–15.
15. Koksal A., Ogul H. Bilateral ureterohydronephrosis associated with cystocele. Br. J. Hospital Med, 2022, vol. 83 (2), pp. 1–11.
16. Ozgul H.A., Altay C., Akin I.B., Secil M. Hydroureteronephrosis due to cystocele. Cukurova Med. J, 2019, vol. 44, pp. 279–280.
17. Trengginas S.S., Wibowo S.A., Tusarawardaya S.A. Multiple vesicolithiasis on cystocele and uterine prolapse. Urol. Ann, 2023, vol. 15 (1), pp. 104–108.
18. Bharucha A.E., Knowles C.H. Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era. Neurogastroenterol Motil, 2022, vol. 34 (11). e14453.
19. Tirumanisetty P., Prichard D., Fletcher J.G. et al. Normal values for assessment of anal sphincter morphology, anorectal motion, and pelvic organ prolapse with MRI in healthy women. Neurogastroenterol Motil, 2018, vol. 30 (7). e13314.
20. Guzman Rojas R., Kamisan Atan I., Shek K.L., Dietz H.P. The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients. Int. Urogynecol. J, 2016, vol. 27 (6), pp. 939–944.
21. Tan C., Geng J., Tang J., Yang X. The relationship between obstructed defecation and true rectocele in patients with pelvic organ prolapse. Sci. Rep, 2020, vol. 10 (1), p. 5599.
22. Bharucha A.E., Lacy B.E. Mechanisms, evaluation, and management of chronic constipation. Gastroenterology, 2020, vol. 158 (5), pp. 1232–1249.e3.
23. Bharucha A.E., Coss-Adame E. Diagnostic strategy and tools for identifying defecatory disorders. Gastroenterol. Clin. North Am, 2022, vol. 51 (1), pp. 39–53.
24. Mustain W.C. Functional disorders: rectocele. Clin. Colon. Rectal. Surg, 2017, vol. 30 (1), pp. 63–75.
25. Hicks C.W., Weinstein M., Wakamatsu M. et al. Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study. Colorectal Dis, 2013, vol. 15 (8), pp. 993–999.
26. Dietz H.P., Gómez M., Atan I.K, Ferreira C.S.W. Association between vaginal parity and rectocele. Int. Urogynecol. J, 2018, vol. 29 (10), pp. 1479–1483.
27. Kim J.H., Kim D.H., Lee Y.P. Long-term comparison of physiologic anorectal changes and recurrence between transanal repair and transanal repair with posterior colporrhaphy in rectocele. Asian J. Surg, 2020, vol. 43 (1), pp. 265–271.
28. Ferrari L., Cuinas K., Hainsworth A. et al. Transvaginal rectocoele repair for the surgical treatment of a «symptomatic» rectocoele when conservative measures fail: A 12 year experience of 215 patients. Neurogastroenterol Motil, 2022, vol. 34 (11). e14343.
29. Grossi U., Horrocks E.J., Mason J. et al. NIHR CapaCiTY working group; Pelvic floor Society. Surgery for constipation: systematic review and practice recommendations: Results IV: Recto-vaginal reinforcement procedures. Colorectal Dis, 2017, vol. 19 (Suppl 3), pp. 73–91.
30. Sun G., de Haas R.J., Trzpis M., Broens P.M.A. A possible physiological mechanism of rectocele formation in women. Abdom. Radiol. (NY), 2023, vol. 48 (4), pp. 1203–1214.
31. Withagen M.I., Milani A.L., de Leeuw J.W., Vierhout M.E. Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG, 2012, vol. 119 (3), pp. 354–360.
32. Luo J., Chen L., Fenner D.E. et al. A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele. J. Biomech, 2015, vol. 48 (9), pp. 1580–1586.
33. Liao Y.H., Ng S.C., Chen G.D. Correlation of severity of pelvic organ prolapse with lower urinary tract symptoms. Taiwan J. Obstet. Gynecol, 2021, vol. 60 (1), pp. 90–94.
34. Chen C.J., Thompson H. Uterine prolapse. 2022 Oct 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
35. Maher C., Yeung E., Haya N. et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst. Rev, 2023, vol. 7 (7). CD012376.
36. Panda A., Khattar N. Pelvic organ descent as a cause of bladder outlet obstruction. Fem. Blad. Outlet Obst. Urethral Rec, 2021, pp. 77–85.