2D and 3D echographic evaluation of the efficiency of treatment for combined types of pelvic organ prolapse and stress urinary incontinence
Objective: To enhance the efficiency of treatment for combined types of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with mesh implants and to introduce an ultrasound-based algorithm for examining patients with this disease.Krasnova I.A., Breusenko V.G., Evseev A.A., Aksenova V.B., Esipova I.A., Pivovarova O.Yu., Golova Yu.A., Surkova E.S., Khashieva F.M.
Materials and methods: The investigation enrolled 51 female patients aged 55±3.0 years with grades 2 and 3 genital prolapse and SUI who had undergone surgical treatment with mesh implants. POP was corrected with the INGyneous mesh implant in 26 patients and with OPUR in 25 examinees. A control group consisted of 32 healthy women of comparable age without POP and SUI. All the patients underwent pre- and postoperative two- and three-dimensional ultrasound examinations in addition to clinical examination. The main parameters of ultrasound-based evaluation were the presence and structure of the pubovesical fascia, the shape of the bladder, α/β angles, and the shape of the urethral sphincters. So, the resulting complete disappearance or pronounced changes in the structure of the pubovesical fascia at the preoperative stage regulate the mandatory correction of cystocele.
Results: Ultrasound performed on days 3–5 after surgery showed that correction of α and β angles, as well as the shape of the bladder to normal values, was achieved in all the patients both in resting and during straining, suggesting that the anatomy of the pelvic organs was properly restored. Assessment of the long-term results indicated that complete and incomplete clinical and ultrasound effects on SUI were achieved in 58.8 and 23.5% of cases, respectively. SUI was relieved completely in 17.6% of the patients. Before surgery, all the patients with preserved SUI were diagnosed to have severe urethral hypermobility, α angle deviation greater more than 40° during the Valsalva maneuver, and funnel-shaped expansion of the proximal urethra, indicating urethral sphincter incompetence. Doppler ultrasound and gray scale imaging could record the reverse flow of urine from the urethra to the bladder due to the inversion of the urethral and vesicular pressure gradient. The combination of similar ultrasound criteria gives a pessimistic prognosis of incontinence. The result of the investigation was to identify the place of ultrasound in the diagnosis of combined forms of POP and SUI.
Conclusion: Thus, surgical treatment for POP with mesh implants is a reliably effective treatment method. Preoperative ultrasound allows prognostic assessment of the correction of SUI in POP.
Keywords
mesh implant
incontinence markers
α
β angle
pubovesical fascia
funnel-shaped urethral dilatation
urethral hypermobility
References
- Dieter A.A., Wilkins M.F., Wu J.M. Epidemiological trends and future care needs for pelvic floor disorders. Curr. Opin. Obstet. Gynecol. 2015; 27(5): 380-4. https://dx.doi.org/10.1097/GCO.0000000000000200.
- Wu J.M., Vaughan C.P., Goode P.S., Redden D.T., Burgio K.L., Richter H.E. et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet. Gynecol. 2014; 123(1): 141-8. https://dx.doi.org/10.1097/AOG.0000000000000057.
- Апресян С.В., Димитрова В.И., Слюсарева О.А. Профилактика развития эстрогензависимых осложнений в предоперационной подготовке женщин с пролапсом гениталий, стрессовым недержанием мочи. Медицинский совет. 2016; 2: 96-9. [Apresyan S.V., Dimitrova V.I., Slyusareva O.A. Prevention of complications of estrogen-dependent complications in preoperative preparation of women with genital prolapse and stress urinary incontinence. Meditsinskiy sovet/Medical Council. 2016; 2: 96-9. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2016-2-96-99.
- Iglesia C.B., Smithling K.R. Pelvic organ prolapse. Am. Fam. Physician. 2017; 96(3): 179-85.
- Lensen E.J.M., Withagen M.I.J., Kluivers K.B., Milani A.L., Vierhout M.E. Urinary incontinence after surgery for pelvic organ prolapse. Neurourol. Urodyn. 2013; 32(5): 455-9. https://dx.doi.org/10.1002/nau.22327.
- Kawasaki A., Corey E.G., Laskey R.A., Weidner A.C., Siddiqui N.Y., Wu J.M. Obesity as a risk for the recurrence of anterior vaginal wall prolapse after anterior colporrhaphy. J. Reprod. Med. 2013; 58(5-6): 195-9.
- Dietz H., Kamisan Atan I., And A.S. The association between ICS POPQ coordinates and translabial ultrasound findings. Ultrasound Obstet. Gynecol. 2016; 47(3): 363-8. https://dx.doi.org/10.1002/uog.14872.
- Люлько А.А. Результаты инструментальных исследований у пациенток с пролапсом гениталий и стрессовым недержанием мочи после хирургического лечения. Вестник проблем биологии и медицины. 2017; 1(4): 194-9. [Lyulko A.A. Results of instrumental studies in patients with genital prolapse and stress urinary incontinence after surgical treatment. Bulletin of Biology and Medicine. 2017; 139(4): 194-9. (in Russian)].
- Khan A.A., Eilber K.S., Clemens J.Q., Wu N., Pashos C.L., Anger J.T. Trends in management of pelvic organ prolapse among female Medicare beneficiaries. Am. J. Obstet. Gynecol. 2015; 212(4): 463.e1-8. https://dx.doi.org/10.1016/j.ajog.2014.10.025.
- Miklos J.R., Chinthakanan O., Moore R.D., Karp D.R., Nogueiras G.M., Davila G.W. Indications and complications associated with the removal of 506 pieces of vaginal mesh used in pelvic floor reconstruction: a multicenter study. Int. Surg. Technol. Int. 2016; 29: 185-9.
- Нечипоренко А.Н. Повторные операции после хирургической коррекции генитального пролапса и стрессового недержания мочи синтетическими сетчатыми протезами. Хирургия. Восточная Европа. 2014; 1: 114-20. [Nechiporenko A.N. Reoperations after surgical correction of genital prolapse and stress urinary incontinence with synthetic mesh prostheses. Surgery. Eastern Europe. 2014; 1(9): 114-20. (in Russian)].
- Касян Г.Р., Тупикина Н.В., Гвоздев М.Ю., Пушкарь Д.Ю. Пролапс тазовых органов и скрытое недержание мочи при напряжении. Экспериментальная и клиническая урология. 2014; 1: 98-102. [Kasyan G.R., Tupikina N.V., Gvozdev M.Yu., Pushkar D.Yu. Pelvic organ prolapse and occult stress incontinence. Experimental and clinical urology. 2014; 1: 98- 102. (in Russian)].
- Евсеев А.А., Краснова И.А., Аксенова В.Б., Пивоварова О.Ю., Суркова Э.С., Багдасарова Я.Э. Оценка эффективности хирургического лечения пролапса тазовых органов с помощью сетчатых имплантатов. Вопросы гинекологии, акушерства и перинатологии. 2019; 18(5): 13-21. [Evseev A.A., Krasnova I.A., Aksenova V.B., Pivovarova O.Yu., Surkova E.S., Bagdasarova Ya.E. Assessment of the effectiveness of surgical treatment of pelvic organ prolapse using mesh implants. Issues of gynecology, obstetrics and perinatology. 2019; 18(5): 13-21. (in Russian)].
- Чечнева М.А., Буянова С.Н., Щукина Н.А., Лысенко С.Н., Барто Р.А. Ультразвуковая диагностика пролапса гениталий и его осложнений у женщин. Sono Ace Ultrasound. 2012; 23: 25-33. [Chechneva M.A., Buyanova S.N., Shchukina N.A., Lysenko S.N., Barto R.A. Ultrasound diagnostics of genital prolapse and its complications in women. Sono Ace Ultrasound. 2012; 23: 25-33. (in Russian)].
Received 28.02.2022
Accepted 05.05.2022
About the Authors
Irina A. Krasnova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, Doctor of the highest category, +7(499)432-96-53, krasnovairina@mail.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.Valentina G. Breusenko, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, Doctor of the highest category, +7(095)432-99-97, breusenkovg@yandex.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.
Alexey A. Evseev, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(499)432-96-53, al_evseev@mail.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.
Victoria B. Aksenova, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(499)432-96-53, viktoriya-aksenova@yandex.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.
Irina A. Esipova, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(499)432-96-53, Esipova.ira@inbox.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.
Oksana Yu. Pivovarova, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(499)432-96-53, pou@mail.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.
Yulia A. Golova, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(499)432-96-53, uasg@mail.ru, 1 Ostrovityanova str., Moscow, 117997, Russia.
Elina S. Surkova, Postgraduate student at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Medical University,
Ministry of Health of Russia, +7(499)432-96-53, surkova.e062@gmail.com, 42 Lobachevsky str., Moscow, 119415, Russia.
Fatima M. Khashieva, Postgraduate student at the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Medical University,
Ministry of Health of Russia, +7(499)432-96-53, fatima.hashieva@mail.ru, 42 Lobachevsky str., Moscow, 119415, Russia.
Corresponding author: Elina S.Surkova, surkova.e062@gmail.com
Authors' contributions: Breusenko V.G. – conception and design of the study; Krasnova I.A. – the clinical supervisor of ultrasound examination on the topic; Evseev A.A. – a surgeon (installation of mesh implants); Pivovarova O.Yu. – a surgical assistant; Aksenova V.B., Esipova I.A., Golova Yu.A. – ultrasound use in patients; Surkova E.S., Khashieva F.M. – material collection and processing, statistical data processing, writing the text, editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The investigation has been approved by the Ethics Committee, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia (Ref. No. 214 of January 24, 2022).
Patient Consent for Publication: All patients provided informed consent for the publication of their data and associated images.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Krasnova I.A., Breusenko V.G., Evseev A.A., Aksenova V.B., Esipova I.A., Pivovarova O.Yu., Golova Yu.A., Surkova E.S., Khashieva F.M. 2D and
3D echographic evaluation of the efficiency of treatment for combined types
of pelvic organ prolapse and stress urinary incontinence.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 5: 140-148 (in Russian)
https://dx.doi.org/10.18565/aig.2022.5.140-148
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