METHOD OF SURGICAL TREATMENT OF RECTOCELE COMBINED WITH APICAL PROLAPSE

The aim of the study is to evaluate the effectiveness of the developed treatment method for rectocele
combined with apical prolapse. Material and methods. The analysis of surgical corrections of pelvic prolapse in 321 patients who went into the Surgut Regional Clinical Hospital since 2013 (the beginning of the implementation of the operations) is performed. A prospective study included 40 patients with a combination of apical prolapse and rectocele divided into groups depending on the method of surgical correction. Eleven patients who received treatment with a new method of one-stage surgical correction represent the first (main) group. The second group (comparison) includes 29 patients with a combination of apical prolapse and rectocele operated without using the new technique. In the statistical processing of the data for quantitative variables, a complex of descriptive statistics is used: 1) quartile values – methods of nonparametric statistics Me (Q1–Q3); 2) comparison of average values in unrelated samples – the Mann–Whitney U test; 3) average values in dynamics in one sample – the Wilcoxon signedrank test; 4) statistical significance of differences in two different samples – the Fisher transformation. Results.
The application of a one-stage surgical correction ensures satisfaction with the surgical intervention. Excellent anatomical results are achieved in the long-term period for ten patients (90.9%) and nine patients (81.8%) had a good functional result.

1. Maher C., Feiner B., Baessler K., Schmid C. Surgical Management of Pelvic Organ Prolapse in Women // Cochrane Database Syst Rev. 2013. No. 4. 99 p.

2. Савельева Г. М., Сухих Г. Т., Серов В. Н., Радзинскй В. Е.,

3. Манухин И. Б. Гинекология : национальное руководство. М. : ГЭОТАР-Медиа, 2017. 1008 с.

4. Gutman R., Maher C. Uterine-Preserving POP // Int Urogynecol J. 2013. Vol. 24. P. 1803–1813.

5. Wallace S. L., Miller L. D., Mishra K. Pelvic Floor Physical Therapy in the Treatment of Pelvic Floor Dysfunction in Women // Current Opinion in Obstetrics and Gynecology. 2019. Vol. 31, No. 6. P. 485–493.

6. Handa V. L., Nygaard I., Kenton K. et al. Pelvic organ Support Among Primiparous Women in the First Year after Childbirth // Int Urogynecol J Pelvic Floor Dysfunct. 2009. Vol. 20. P. 1407–1411.

7. Soligo M., Livio S., De Ponti E. et al. Pelvic Floor Assessment after Delivery: How Should Women be Selected? // Eur J Obstet Gynecol Reprod Biol. 2016. Vol. 206. P. 153–157

8. Бююль А., Цёфель П. SPSS: Искусство обработки инфор-

9. мации. Анализ статистических данных и восстановление скрытых закономерностей. СПб. : ДиаСофтЮП, 2005. 608 с.

10. Geynisman-Tan J., Kenton K. Surgical Updates in the Treatment of Pelvic Organ Prolapse // Rambam Maimonides Medical Journal. 2017. Vol. 8, No. 2. Р. 1–12.

11. Rosenblum N. Pelvic Organ Prolapse: Considerations in Surgical Management. NYU Case of the Month // Rev Urol. 2017. Vol. 19, No. 2. P. 134–137.

12. Jonsson F. M., Edenfield A. L., Pate V., Visco A. G., Weidner A. C.,

13. Wu J. M., Jonsson F. M. Trends in Use of Surgical Mesh for Pelvic Organ Prolapse // Am J Obstet Gynecol. 2013. Vol. 208, No. 1. P. 79.

14. Pelvic organ prolapse. ACOG Practice Bulletin No. 214 // Obstet Gynecol. 2019. Vol. 134, No. 5. P. e126–e142.

15. Шкарупа Д. Д., Кубин Н. Д. Протезирующая реконструкция тазового дна влагалищным доступом: современный взгляд на проблему // Экспериментальная и клиническая урология. 2015. № 1. С. 88–93.

16. Mourtialon P., Letouzey V., Eglin G., de Tayrac R. Cystocele Repair by Vaginal Route: Comparison of Three Different Surgical Techniques of Mesh Placement // Int Urogynecol J. 2012. Vol. 23, No. 6. P. 699–706.

17. Prentice A., Bazzi A. A., Aslam M. F. Treatment Patterns of Primary Care Physicians Vs Specialists Prior to Subspecialty Urogynaecology Referral for Women Suffering from Pelvic Floor Disorders // World Journal of Methodology. 2019. Vol. 9, No. 2. Р. 26–31.

18. Ko K. J., Lee K.-S. Current Surgical Management of Pelvic Organ Prolapse: Strategies for the Improvement of Surgical Outcomes // Investig Clin Urol. 2019. Vol. 60, No. 6. P. 413–424.

19. Sung V. W., Rogers R. G., Schaffer J. I., Balk E. M., Uhlig K., Lau J. et al. Society of Gynecologic Surgeons Systematic Review Group. Graft Use in Transvaginal Pelvic Organ Prolapse Repair: a Systematic Review // Obstet Gynecol. 2008. Vol. 112, No. 5. P. 1131–1142.

20. Feiner B., Jelovsek J. E., Maher C. Efficacy and Safety of Transvaginal Mesh Kits in the Treatment of Prolapse of the Vaginal Apex: a Systematic Review // BJOG. 2009. Vol. 116. P. 15–24.

21. Шкарупа Д. Д., Шпиленя Е. С., Кубин Н. Д. Основные проблемы, ассоциированные с применением синтетических сетчатых эндопротезов во влагалищной хирургии недержания мочи и тазового пролапса на современном этапе // Медицинский вестник Башкортостана. 2013. Т. 8,

22. № 2. C. 172–175.

23. Шкарупа Д. Д., Кубин Н. Д., Попов Э. Н., Шаповалова Е. А., Зайцева А. О. Унилатеральный апикальный слинг – новый взгляд на сакроспинальную фиксацию // Журнал акушерства и женских болезней. 2019. Т. 68, № 1.

24. C. 37–46.

25. Lee R. K., Mottrie A., Payne C. K., Waltregny D. A Review of the Current Status of Laparoscopic and Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse // European Urology. 2014. Vol. 65, No. 6. P. 1128–1137.

26. Claerhout F., De Ridder D., Roovers J. P. et al. Mediumterm

27. Anatomic and Functional Results of Laparoscopic Sacrocolpopexy Beyond the Learning Curve // Eur Urol. 2009. Vol. 55. P. 1459–1468.

28. Knowles C. H., Grossi U., Horrocks E. J., Pares D., Vollebregt P. F.,

29. Chapman M. et al. Surgery for Constipation: Systematic Review and Practice Recommendations: Graded Practice and Future Research Recommendations // Colorectal Dis. 2017. Vol. 19, No. 3. P. 101–113.

30. Rooney K., Kenton K., Mueller E. R., FitzGerald M. P., Brubaker L.

31. Advanced Anterior Vaginal Wall Prolapse is Highly Correlated with Apical Prolapse // Am J Obstet Gynecol. 2006. Vol. 195, No. 6. P. 1837–1840.