The thesis is devoted to the solution of scientific problems - improving the effectiveness of treatment of patients with recurrent genital prolapse and fewer intraoperative and postoperative complications through the development and implementation of evidence-based algorithm survey, preparation for surgery, the surgical correction of pathology and postoperative rehabilitation. Were questioned and examined 1795 patients aged 45 to 77 years, on average 57,4±5,6 years, after surgery for genital prolapse (GP). Patients performed surgery to correct the fascial structures and ligaments of the genitals without the use of synthetic materials or removal of the uterus, for various reasons during the period from 2003 to 2008. Found that in 61,4 % of patients observed the formation of signs of relapse after correction of genital prolapse by the body's own tissues. Of these, every second patient to re- surgery (56,2 %), and every third patient will be operated on again. On the basis of clinical and epidemiological studies identified the main risk factors for RGP: iatrogenic created or undiagnosed violation fascial structures and ligaments of the genitals, gynecological and extra CTD, diseases that lead to increased intra-abdominal pressure, hypoestrogenic state in menopause, inflammation of the vaginal mucosa, material support and technique of surgical interventions. Found that the major risk factors for RGP is that CTD was diagnosed in 71,8 % of patients with RGP and diseases that cause an increase in intra-abdominal pressure: asthma 28,3 %, chronic digestive diseases - 23,5 %. The risk of RGP increased obstetric and social factors: heavy physical work 11,2 %, overweight 36,5 % of the body, tears and episiotomies during childbirth 24,1 %. In the specific features of biochemical markers of CTD - increase the level of hydroxyproline fractions in the blood levels of sex hormones - hypoestrogenic, hyperandrogenic. Established MRI criteria specific to various types of RSE in menopausal women: thinning and separation of the urogenital fascia of the pelvic support structures, the gap separation and thinning of the rectovaginal fascia, stretching the locking apparatus of the uterus and lower anatomical landmarks below PKL. Dynamic MRI allowed in 61,1 % of patients with RSE diagnose latent defects fascia and ligaments, to objectively evaluate and take into account the relationship between the segments, in 41,7 % of cases correctly assess the competing views of the defect in detail to plan the future of surgery. First developed and implemented evidence-based treatment algorithm for women with various forms of RSE based compensation degree of prolapse, gynecologic pathology, the severity of the DST, thus improving the quality of life and the effectiveness of treatment of patients with RSE, reduce the frequency of recurrent relapses to 3,8 % (p<0,001), to reduce the number of postoperative complications by 19,4 % (p<0,05), while hospitalization by 58,2 % (p<0,02) in 81,3 % of cases of organ perform reconstructive surgery. Embedded methods reduce the risk of relapse by 94,1 % (p<0,001), which allows us to recommend their widespread use in gynecological hospitals for treatment of primary and recurrent forms of genital prolapse.
