Abstract
High rate of recurrence after surgical correction remains the key problem of the pelvic organ prolapse (POP) treatment, while the key objective is the search for the ways to improve surgical techniques. Various surgical approaches, including minimally invasive, involving the use of mesh implants or native tissues have been developed, but neither patients, nor surgeons are satisfied with the results.
Aim: to analyze available scientific data on the efficacy and safety of surgical correction methods in terms of genital prolapse recurrence.
Methods. Analysis of scientific papers published in the ELibrary, PubMed, CochraneLibrary, Science Direct databases in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “rectocele/ректоцеле”, “cystocele/цистоцеле”, “apical prolapse/апикальный пролапс”, “recurrence/рецидив”, “surgical treatment/оперативное лечение” was performed.
Results. To date, no perfect surgical approach to treatment of POP has been developed; no optimal surgical procedures for correction of primary and recurrent POP allowing one to avoid the disease progression have been proposed. A comprehensive personalized approach based on thorough assessment of the pelvic floor condition taking into account all the existing risk factors of primary POP or new disease progression factors in case of recurrence is the key to reducing the POP recurrence rate.
Conclusion. Verification of fascial defects during preoperative and intraoperative periods is believed to be critical for improvement of the POP surgical treatment outcomes. Sufficient extent of surgical intervention, elimination of all fascial defects, optimal use of MESH technologies might improve anatomical and subjective operative results, as well as reduce the risk of recurrence. The use of synthetic implants in a number of studies has proven to be effective, regardless of the ongoing discussions about safety of such methods. It is necessary to continue the research on a large sample, since it will make it possible to improve the long-term treatment outcomes.
Keywords: pelvic organ prolapse, rectocele, cystocele, apical prolapse, recurrence, surgical treatment.
Aim: to analyze available scientific data on the efficacy and safety of surgical correction methods in terms of genital prolapse recurrence.
Methods. Analysis of scientific papers published in the ELibrary, PubMed, CochraneLibrary, Science Direct databases in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “rectocele/ректоцеле”, “cystocele/цистоцеле”, “apical prolapse/апикальный пролапс”, “recurrence/рецидив”, “surgical treatment/оперативное лечение” was performed.
Results. To date, no perfect surgical approach to treatment of POP has been developed; no optimal surgical procedures for correction of primary and recurrent POP allowing one to avoid the disease progression have been proposed. A comprehensive personalized approach based on thorough assessment of the pelvic floor condition taking into account all the existing risk factors of primary POP or new disease progression factors in case of recurrence is the key to reducing the POP recurrence rate.
Conclusion. Verification of fascial defects during preoperative and intraoperative periods is believed to be critical for improvement of the POP surgical treatment outcomes. Sufficient extent of surgical intervention, elimination of all fascial defects, optimal use of MESH technologies might improve anatomical and subjective operative results, as well as reduce the risk of recurrence. The use of synthetic implants in a number of studies has proven to be effective, regardless of the ongoing discussions about safety of such methods. It is necessary to continue the research on a large sample, since it will make it possible to improve the long-term treatment outcomes.
Keywords: pelvic organ prolapse, rectocele, cystocele, apical prolapse, recurrence, surgical treatment.
For citation:Orazov M.R., Radzinsky V.E., Minnullina F.F. Surgical treatment of recurrent pelvic organ prolapse: what is important to know? Clinical review for general practice. 2025; 6 (2): 106–112 (In Russ.). DOI: 10.47407/kr2024.6.1.00558
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