Euromedica 2011 A.B. Medvedeva I.K. Tseretelly G.V. Manaeva E.A. Kuzmenko E.V. Konoplyanik L.P. Razlivinskikh the use of synthetic materials for surgical correction of female genital prolapse"

A.B. Medvedeva I.K. Tseretelly G.V. Manaeva E.A. Kuzmenko E.V. Konoplyanik L.P. Razlivinskikh	THE USE OF SYNTHETIC MATERIALS FOR SURGICAL CORRECTION OF FEMALE GENITAL PROLAPSE
	Municipal Health Care Institution “City clinical hospital No.1 Togliatti”, Russia

Despite a great number of ways to correct genital prolapse and uroclepsia (more than 300 types of surgery) new methods are still being developed due to high rate of recurrences (between 2,3 and 33 %). The reason for high rate of recurrences is initial disorder of connective tissue diagnosed at 50% patients with genital prolapse. This factor brought up the idea to use synthetic material to replace fascial structures of pelvic ﬂoor. Age of women has been between 42 and 74. Women occupied at physically demanding jobs were of 28%. The obstetric accidents constitute 43% of patients. Obesity diagnosed at 24% of women, varicosity was in 52%. The period of disease duration was between 3 and 10 years In cases of kulti vaginal prolapse or in laparoscopic hysterectomy at the second stage we carried out MESH- sacrovaginal suspension (n=11). The method of vaginal extraperitoneal colpopexy is provided to 92 patients. For cystocele plasty we used transobturator access by ﬁxation of free prosthesis parts with distal and proximal parts arcus tendineus according to Prolift anterior method (Johnson & Johnson, USA) in original modiﬁcation; back wall of vagina was supported by prosthesis led through lig. sacrospinosus according to Prolift posterior method with the help of original transforator. In case of uterus prolapse (full or partial) vaginal hysterectomy was made combined with Prolift total. When we deﬁned stress incontinence we made suburethral ﬁxation with transobturator sling ТОТ (Johnson & Johnson, USA). This method was successfully applied to 57 women. We cut prosthesis by ourselves from polypropylene with soft index depending on focalization, form and size of fascia defect correcting genital prolapse for 62 women. The efﬁciency of operative treatment was evaluated within the period between 6 months and 5 years given subjective and objective criteria for recovery of anatomic parameters and functional indicators (absence of dyspareunia, constipation pains). We can state that operative treatment of pelvic prolapse and stress urinary incontinence by using synthetic materials is very efﬁcient. We observed complete recovery of anatomical structures, pelvic ﬂoor functions and absence of recurrences. All patients were satisﬁed with surgery results and improvement of their quality of life. We would like to emphasize that sling surgeries are easy to carry out, there are no hemorrhagic and communicable complications, and aftercare period decreases signiﬁcantly.

Summary: The prolene mesh prosthesis with soft index is today the best synthetic material in terms of physical and biological characteristics for operative treatment of prolapse and abasement of genitals. Short-term results showed the safety of mesh prosthesis ﬁxation with pelvis dense structures - membrana obturatorium, arcus tendineus, lig.sacrospinosus. It can be used in vaginal extraperitoneal colpopexy with Prolift original set for correction of genital prolapse. Vaginal extraperitoneal colpopexy under Prolift method could be a good alternative for other types of operative treatment of genital prolapse due to low traumatism and use solely vaginal access; this method can also be applied to patients with severe extra genital disorder.