Combined pelvic floor repair in Levels I and II support defects: Posterior intravaginal sling and subfascial colporrhaphy
Most female patients operated on for pelvic organ prolapse (POP) have a concurrence of DeLancey Levels I and II support defects. This necessitates their single-stage correction. In addition, it is appropriate to reduce the amount of synthetic material used in reparative operations. Objective. To evaluate the efficiency of combined treatment for POP through bilateral sacrospinal fixation of the synthetic prosthesis - a posterior intravaginal sling (urosling 1, OOO «Lintex») in combination with subfascial colporrhaphy. Subjects and methods. This retrospective study covered 166 women with posthysterectomic prolapse, as well as with a concurrence of apical prolapse and anterior/posterior colpoptosis. The patients underwent combined pelvic floor repair in accordance with the proposed procedure. The data of vaginal examination (using the POP quantification (POP- Q) staging system), uroflowmetry, and bladder ultrasonography, which had been determined preoperatively and during control examinations at 1, 3, 6, and 12 months postoperatively, were used to assess the results of surgical treatment. The change in quality of life was estimated comparing the scores of the questionnaires PFDI-20, PFIQ-7, PISQ-12, and ICIQ-S. Results. The mean follow-up was 18 months. The mean surgery duration was 32 minutes. Analysis of POP-Q scores revealed statistically signif icant (P< 0.05) improvements in all the patients. It is important to note that there was an increase in maximal flow rates and a reduction in residual urine volumes in patients having cystocele (P<0.001). When 12 months elapsed, there were the following complications: de novo urgency and de novo stress urinary incontinence in 4 (2.4%) and 3 (1.8%) patients, respectively. De novo prolapse was noted in 1 (0.6%) patient. A comparison of the scores of the questionnaires also revealed a significant improvement in quality of life postoperatively in women. Assessment of patient satisfaction showed that 87.9% were very satisfied; 9.6% reported a slight or significant improvement. Conclusion. Bilateral sacrospinous fixation through vaginal approach applying a current monofilament synthetic endoprosthesis-tape in combination with native tissue repair of the pelvic floor may be highly efficiently and safely used in patients having a concurrence of defects in pubocervical and rectovaginal fascias with damages to the sacrouterine and cardinal ligamentous apparatus.