OBJECTIVE
To evaluate the clinical efficacy and impact of neodymium laser on the biomechanical properties of the vaginal wall in patients with grade I-II pelvic organ prolapse.
MATERIALS AND METHODS
A total of 92 patients aged 35—50 years were examined, including 54 with a confirmed diagnosis of grade I-II pelvic organ prolapse, and 38 without prolapse, but with pathology requiring surgical intervention with the possibility of vaginal wall biopsy. Three obser-vation groups were formed: Group 1 — 38 patients without pelvic organ prolapse, operated for other indications with obtaining vaginal wall fragments; group 2 — 12 patients who underwent surgery for grade I—II pelvic organ prolapse — anterior and / or posterior colporrhaphy without treatment in the preoperative period; group 3 — 42 patients with pelvic organ prolapse, who re-ceived laser therapy in the preoperative period, and then surgical intervention — anterior and / or posterior colporrhaphy. Laser irradiation of the vaginal wall was performed using a neodymium (Nd:YAG) laser in three procedures with an interval of 1 month as preoperative preparation. In 21 patients, the elastic properties of the vaginal wall tissues were studied ex vivo with biopsy samples using phase-sensitive compression optical coherence elastography (C-OCE) with simul-taneous histological examination. Histological samples were prepared in accordance with the standard procedure and stained according to standard protocols with hematoxylin and eosin for a preliminary assessment of the tissue structure and according to van Gieson for a quantitative and qualitative assessment of collagen fibers of the submucosal layer.
RESULTS
It was clinically established that laser therapy has no side effects and complications, an increase in the vaginal health index almost to normal values. Convincing data on structural reor-ganization of the connective tissue submucosal layer of the vaginal wall in women with prolapse, which determines its resistance to stretching under the influence of various factors, were ob-tained. In particular, a decrease in rigidity, a decrease in the thickness of collagen bundles, and the development of destructive processes were observed. On the contrary, the nature of reorgani-zation of the vaginal wall tissues after exposure to the Nd:YAG laser was determined by an in-crease in the quantitative indices of connective tissue structures of the submucosal layer of the vaginal wall during histological examination and restoration of rigidity in C-OCE images, which indicates an intensification of regeneration and an improvement in the morphometric parameters of the tissue.
CONCLUSION
The positive changes in the biomechanical properties of the vaginal wall revealed are the result of laser-induced reorganization of the subepithelial layer of the vaginal wall, which, together with the positive changes in the clinical picture, allows us to make a preliminary conclu-sion about the pathogenetic significance of using a neodymium laser in the complex treatment of patients with grade I—II prolapse.
