Disturbance of local hemodynamics as a key mechanism of pelvic organ prolapse recurrence
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), Associate Professor, Head of the Department of Obstetrics and Gynecology at the Institute of Fundamental Medicine and Biology
Address: 18 Kremlevskaya St., Kazan, Russian Federation, 420008, tel.: +7-987-233-04-78, e-mail: minnullina_f@mail.ru
Pelvic organ prolapse (POP) is a common condition with its incidence in the female population increasing with age. The severity of symptoms increases with the degree of genital prolapse, from asymptomatic to significant impact on quality of life, which becomes an indication for surgical treatment. The lifetime risk for women to undergo surgery for POP is estimated at 10%.
Surgical reconstruction is the most effective method of treatment, but is associated with a high risk of recurrence — up to 50%. This necessitates the search for treatment approaches that reduce the likelihood of symptom recurrence after surgical treatment. To this end, it is necessary to have a clear understanding of the POP recurrence development.
The purpose — to analyze the data on the mechanisms of POP recurrence, wound healing and hemodynamics disturbance in the soft tissues of the pelvic floor after surgical reconstruction.
Material and methods. We analyzed the evidence data published in PubMed, CochraneLibrary, ELibrary, and Science Direct electronic libraries by the keywords «pelvic organ prolapse», «recurrence», «pathogenesis», «microcirculation», «wound healing» from 2010 to 2024.
Results. Based on the work performed, it was found that the quality of wound healing in the postoperative period can affect the mid- and long-term results of surgical reconstruction of the pelvic floor, and the risk of recurrence. However, we found an extremely limited available knowledge about the pathogenesis of recurrent POP, impaired wound healing of pelvic floor after surgical treatment, which makes it difficult to develop targeted therapeutic and preventive measures.
Conclusions. To develop effective perioperative strategies to reduce the risk of POP recurrence, it is necessary to clearly understand the mechanisms of impaired wound healing and hemodynamics in the pelvic floor soft tissues after surgical intervention. Qualitative morphologic, immunohistochemical and molecular-biologic studies on large samples are necessary to expand the understanding of recovery after the small pelvis surgical reconstruction and to study the peculiarities of soft tissue repair.
Key words: pelvic organ prolapse, pelvic floor muscle dysfunction, recurrence, pathogenesis, hemodynamics, pelvic floor soft tissue repair, surgical treatment.
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