Surgical Treatment Of Central Compartment Pelvic Organ Prolapse

Objective: To investigate the clinical difference between the traditional vaginal hysterectomy and other POP operations(sacral spine ligament fixation and laparoscopic sacral fixation),the applications of synthetic mesh and uterus conservation in POP surgery were studied on the evaluation of their clinical values.Methods: 160 cases of women with Pelvic Organ Prolapse Quantification System(POP-Q)stage Ⅱ~Ⅳ central compartment prolapse opting surgical treatment in ****** Hospital between January 2013 to January 2017 were studied.They were grouped in three way:the surgical approach,the application of the mesh,and the uterus conversation.The cases were divided into Groups A(vaginal hysterectomy)39 and B(other mid-compartment operations)121,Groups MM(mesh group)93 and NM(non-mesh group)67,and Groups HT(uterus resection)139 and UC(uterus conversation)21,respectively.The clinical data in each couple of groups was statistically analyzed.Results: General stuff: Between Groups A and B,there were no significant differences in terms of age,years since menopause(YSM),parity,medical diseases,and POP-Q stage(P>0.05).Between Groups MM and NM,there was a significant difference in age(P<0.05),suggesting that the mean age in Group MM was less than that in Group NM.Between Groups UC and HT,there were significant differences in terms of YSM and parity(P<0.05).The mean values of them in Group UC were less than those in Group HT.Perioperative data: Between Groups A and B,there were significant differences in terms of operation time,blood loss,and catheterization time(P<0.05),while no statistical difference in postoperative hospitalization stay(P>0.05).It suggested that Group A had the less bleeding,shorter operation time,and longer postoperative hospitalization stay than Group B.Between Groups MM and NM,there were significant differences in terms of operation time,bleeding,and postoperative hospitalization stay(P<0.05).It suggested that Group MM had longer operation time,more bleeding and longer postoperative hospitalization stay than Group NM.Between Group UC and HT,there were significant differences in terms of operation time,catheterization time and postoperative hospitalization stay(P<0.05)while no significant difference in intraoperative blood loss(P>0.05).It suggested that Group UC had the longer operation time,shorter catheterization time,and fewer postoperative hospitalization stay than Group HT.Postoperative recurrence: In the follow-up of 12-48 months,it was found that 4 cases of objective recurrence and 1 case of both subjective and objective recurrence.Postoperative satisfaction from patients: Based on the PGI-I table of clinical satisfaction from patients(P<0.01),there was no significant difference in satisfaction between Groups A and B(P> 0.05).While the couple of Groups NM and MM and the couple of Groups HT and UC had the statistically significant differences(P<0.05).It suggested that Group UC/MM had more satisfaction with treatment than Group HT/NM.Surgical complications: All complications included:1 intraoperative bleeding(0.6%),6 postoperative urinary retention(3.75%),15 postoperative pain(9.38%),1 mesh exposure(0.6%),no peripheral organ injury.Conclusion: 1.Traditional vaginal hysterectomy has short operation time,less bleeding,fewer complications,and does not need special instrument and materials.It is a easy and effective surgical approach for patients with POP stage Ⅱ~Ⅳ who do not need to keep the uterus,but its recurrence rate is slightly higher.2.Modern POP repair surgery is based on Integral theory.The surgical approach with selfbody tissue or prosthetic materials varies from compartment to compartment in pelvic floor defects,which has obvious individualization and good curative effect.But it has mutiple approaches,complex procedures and longer operation time.3.The synthetic mesh plays an important complementary role together with self-body tissue,which is helpful in POP repair operations for the patients with POP-Q stage Ⅲ~Ⅳ.Precise anatomy,suitable mesh and tension-free implantation will lead to fewer complications.4.POP repair surgery with uterus conservation maintains the integrity of the pelvic floor anatomy.It dose not increase surgical risk to achieve satisfactory surgical outcome in the treatment of POP,especially for the young patients.