The dissertation is devoted to the current problem of gynecology - increasing of
effectiveness of surgical treatment to combined uterine leiomyoma with genital prolapse
by developing a differentiated approach to the volume and options for surgical delivery in
this category of patients.
The research was conducted in two consecutive stages. The first stage aimed to establish
the relationship between uterine leiomyoma and the risk of development and progression
of genital prolapse, for which a retrospective cohort study was performed among 240
consecutively recruited patients who were treated at the Kyiv City Center for Reproductive
and Perinatal Medicine during 2019-2020. Study group consisted of 117 women with
prolapse of the internal genital organs were compeared to 123 women with normal
anatomy of the pelvic organs.
At the second stage, a prospective controlled clinical trial of the effectiveness of
surgical treatment of patients with uterine leiomyoma and initial stages of prolapse was
conducted. To solve the research tasks, 120 women aged 34 to 67 years were examined
(on average (M±σ) – 49.6±8.03 years), who were divided into 2 groups depending on the
type of surgical intervention. The control group consisted of 40 women who underwent
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amputation or extirpation of the uterus without correction of genital prolapse due to
uterine leiomyoma.
The main group included 80 patients who underwent correction of genital prolapse
by pectopexy or lateral fixation at the same time as hysterectomy. For surgical correction
of genital prolapse, a mesh implant was used. Wide part of mesh was fixed to the front
wall of vaginal stump and the stump of the cervix (in case of supravaginal amputation of
the uterus) with the help of knotted sutures at 6-8 points of fixation, the long legs were
fixed with knotted stitches to the Cooper's ligaments on both sides alternately (pectopexy)
or contra-laterally ( lateral fixation). Selected groups of patients were compared according
to the main clinical and demographic characteristics.
The research methodology was based on the evaluation of the general somatic and
gynecological status, quantitative assessment of the stage of genital prolapse according to
the international classification of pelvic organ prolapse quantification - Pelvic Organ
Prolapse Quantification system (POP-Q), ultrasonography results. The quality of life of
the participants was studied using specialized questionnaires PFDI-20 (The Pelvic Floor
Distress Inventory) and PD-QL ("Prolapse (of the pelvic organs), dysfunction (of the
pelvic floor) and quality of life"), sexual function - with the help of PISQ (Pelvic Organ
Prolapse and Incontinence Sexual Function Questionnaire), PSI (Patient Satisfaction
Index) was used to determine the satisfaction of patients with surgical treatment.
The primary outcome of the study was the anatomical outcome of the performed
surgical intervention according to the POP-Q assessment results. Subjective and objective
prolapse symptoms, quality of life, sexual function, and patient satisfaction with surgical
treatment were evaluated as secondary outcomes.
Uterine leiomyoma is one of the most common benign pelvic neoplasms in women.
The fact that in more than 60% of cases of uterine leiomyoma is diagnosed in
perimenopausal or postmenopausal periods, that is, in the age category of women with a
high frequency of genital prolapse, causes the frequent combination of these two
pathologies. Research suggests that uterine leiomyoma is a likely risk factor for pelvic
organ prolapse. In addition, a large number of literary sources is focused on identifying
potential risk factors for the progression of genital prolapse, as well as on determining the
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tactics of operative treatment of combined pathology of the uterus without and with genital
prolapse.
The predominance of the frequency of uterine leiomyoma (44.4%) compared to
other gynecological diseases in women with genital prolapse was established. Building a
logistic model made it possible to demonstrate the influence of age, a sedentary lifestyle,
excessive physical exertion, family history of genital prolapse, uterine leiomyoma, the
total number of intrauterine manipulations, the number of pregnancies, and perineal tears
on the development of pelvic floor prolapse.
