Мodern approaches to diagnosis and conservative treatment of genital prolapse in women in the practice of gynecologist
Objective. To acquaint readers with modern approaches to diagnosis and treatment of genital prolapse in women.Apolikhina I.A., Chochueva А.S., Saidova А.S., Gorbunova Е.А., Kagan I.I.
Material and methods. A systematic review of the published literature on the diagnosis and treatment of pelvic organ prolapse (POP).
Results. Analysis of published data shows that modern principles of diagnosis of genital prolapse, such as perineal ultrasound 2D and 3D ultrasound, greatly extends the examination of patients with pelvic floor changes, it allows to objectify the process of examination and treatment.
The use of pessaries is the first line of conservative treatment POP. A variety of shapes and sizes allows individual selection of the desired type for each patient. Pessaries have virtually no contraindications, which allows to recommend them almost all patients with POP.
Conclusion. Taking into account the efficiency of the above approaches to diagnosis and treatment of genital prolapse in women, it is necessary their implementation in practical healthcare.
Keywords
pessaries
pelvic organ prolapse
urinary incontinence
conservative treatment
Supplementary Materials
- Table 1. Symptoms of pelvic organ prolapse
- Тable 2. Pelvic Organ Prolapse Quantification System (POP-Q)
- Table 3. Muscle Strength Grading Scale (Oxford Scale)
- Figure 1. The anatomical landmarks to determine the degree of pelvic organ prolapse by POP-Q.
- Figure 2. The structure of m. levator ani.
- Figure 3. Levator ani muscle palpation demonstrated using a model. (a) Normal left-side levator ani muscle (L) attachment. (b) Right-side avulsion. PB, pubic bone; U, urethra.
- Figure. 4. Diagrammatic representation of classification system for palpation of levator ani muscle (LAM) avulsion
- Fig. 5 A. The patient of 65 years with POP, before the introduction of the pessary. During the uroflowmetry marked obstructive voiding type: reduced max. urinary flow rate (7.4 ml / s) environments. rate of urination and urine volume at miktsii. Fig. 5 B. The same patient after the introduction of the pessary. Restoration of normal indicators - non-obstructive urinary type: max. urination rate (20.6 ml / sec), and residual urine volume reduction to 0 ml.
- Fig. 6. The patient, 69 years old. Pelvic organ prolapse 3 stage. Figure a) before and c) after the introduction of the pessary.
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Received 17.10.2016
Accepted 11.11.2016
About the Authors
Apolikhina Inna A., MD, professor, obstetrician-gynecologist of the highest category, a physical therapist, head of the department of gynecology and aesthetic rehabilitation, Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor, Department of Obstetrics, Gynecology, Perinatology and Reproductive, First Moscow State Medical University, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: i_apolikhina@oparina4.ruChochueva Adalina S., resident of the 1st year of study, Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79262628361
Saidova Aina S., MD, obstetrician-gynecologist gynecology department of aesthetic and rehabilitation, Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79262066051. E-mail: dr.saidova@gmail.ru
Gorbunova Elena A., obstetrician-gynecologist, a physiotherapist aesthetic gynecology department and rehabilitation, Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: el_gorbunova@oparina4.ru
Kagan Ilya I., MD, professor of Prof. S.S. Mikhailov Department of Operative Surgery and Topographic Anatomy, Orenburg State Medical Academy.
460000, Russia, Orenburg, Sovetskaya str. 6. E-mail: kaganil@mail.ru
For citations: Apolikhina I.A., Chochueva А.S., Saidova А.S., Gorbunova Е.А.,
Kagan I.I. Мodern approaches to diagnosis and conservative treatment
of genital prolapse in women in the practice of gynecologist.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (3): 26-33. (in Russian)
http://dx.doi.org/10.18565/aig.2017.3.26-33
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