OBJECTIVE

To improve the results of surgical treatment in severe forms of genital prolapse and their combination with uterine pathology, stressful urinary incontinence or with its latent form and incontinence of gases and stools in elderly and senile patients by optimizing surgical techniques.

MATERIAL AND METHODS

The study included 32 patients aged 65 to 80 years with severe forms of genital prolapse after selection for a number of the most important factors, including the presence of concomitant pathology of the uterus (detected in 100% of patients), involvement of adjacent organs (with the development of urinary incontinence during exertion or its latent form, incontinence of gases and feces), the presence of severe extragenital pathology (coronary artery disease, hypertension, atrial fibrillation, various forms of diabetes mellitus). An important factor was the lack of sexual activity both at the present time and in the future.

RESULTS

A set of diagnostic measures was carried out aimed not only at objectively confirming the presence of severe forms of genital prolapse, but also to a greater extent at identifying additional aggravating factors affecting the course of the pathological process, determining the degree of dysfunction of adjacent organs and, most importantly, predicting the effectiveness of the selected extent of surgical treatment. The proposed tactics of surgical correction of severe forms of genital prolapse include a combination of urethropexy of the middle third of the urethra with a free synthetic loop and vaginal extirpation of the uterus with median colporaphy to minimize the risks of recurrence, while avoiding onco-alertness and the risks of developing purulent-septic complications in the delayed period during median colporaphy in its classical execution. The final stage of surgical treatment is colpoperineosphincterolevatoroplasty in order to create a higher perineum, improve the function of the rectum and aesthetics. The average duration of surgical intervention ranged from 55 to 75 minutes. During the study, none of intra- and postoperative complication was registered.

CONCLUSIONS

The proposed tactics of surgical management of severe forms of genital prolapse are one of the methods of surgical treatment choice, being highly effective with low recurrence.