Clinical Evaluation Of Modified Total Pelvic Floor Reconstruction Surgery On Female Pelvic Organ Prolapse And Its Effect On Sexual Function

Objective:To investigate the clinical effect of modified total pelvic floor reconstruction surgery on female pelvic organ prolapse(POP)and its effect on sexual function.Methods:The clinical data of 160 female patients with moderate to severe POP who underwent modified total pelvic floor reconstruction surgery in the urology department of the First Affiliated Hospital of Kunming Medical University from September 2015 to December 2018 were collected and retrospectively analyzed.Perioperative parameters and surgical complications were recorded.All the patients were followed up and asked to record Pelvic Organ Prolapse Quantification score and to complete pelvic floor impact questionnaire brief form before operation,and it was repeated 3 months,6 months and 1 year after operation.Anatomical outcomes were assessed using Pelvic Organ Prolapse Quantification(POP-Q)staging.POP-Q was used to evaluate the recovery of various anatomical sites after operation.The subjective outcomes and patients’ quality of life were evaluated through Pelvic Floor Distress Inventory-short Form 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7)and Patient Global Impression of Change(PGI-C).They were mainly used to assess patients’ POP symptoms and quality of life improvement.The patients’ quality of sexual life was evaluated through Prolapse and Incontinence Sexual Questionnaire 12(PISQ-12).To evaluate the safety of modified total pelvic floor reconstruction surgery,and to analyze and discuss the occurrence and preventive measures of intraoperative and postoperative complications.Results:1.Perioperative parameters:All 160 patients underwent modified total pelvic floor reconstruction surgery.The average operation time and hemorrhage each was(86.54±15.73)min、(54.41±16.15)ml,The average postoperative hospital stay and urinary catheter indwelling time each was(3.24±1.18)、(2.30±0.85)d.2.Objective outcomes:All the patients were overall POP-Q stage≤I after surgery.Comparing with the preoperative POP-Q score,the positions of Aa,Ap,Ba,Bp,C,Pb,Gh and TVL in each anatomical site after surgery have significantly changed,the difference was statistically significant(P＜0.05).The operation achieved a successful anatomical reduction.3.Subjective outcomes:All patients completed at least lyear follow-up evaluation after surgery.Postoperative PFDI-20,PFIQ-7 scores and sub-questionnaire score were significantly lower than before operation,the difference was statistically significant(P＜0.05).postoperative PGI-C score was significantly increased than before operation,the difference was statistically significant(P＜0.05).46(28.75%)patients had sex life within 6 months before operation.The PISQ-12 score at 6 months and 1 year after surgery was higher than before surgery,the difference was statistically significant(P＜0.05).4.Surgical complications:There were no bladder,urethral,rectal and vascular nerve injuries during the operation.7(4.37%)patients had difficulty urinating after extubation,4(2.50%)patients had postoperative infection,and 3(1.87%)patients had new urinary incontinence.Overactive bladder and pain are the main short-term complications after surgery.The incidences of overactive bladder and pain within 1 month after surgery each was 8.75%and 7.50%.1(0.63%)patient had difficulty in having sexual intercourse in 3 months after operation,and 3(1.87%)patients had difficulty in having sexual intercourse in 6 months after operation.Mesh exposure or erosion and prolapse recurrence are the major long-term complications.One patient(0.63%)had recurrence of prolapse at 3 months after surgery,and one(0.63%)patient had a mesh at 6 months Exposure or erosion,the incidence rate of both was 1.25%within 1 year after surgery.Conclusions:1.Compared with traditional surgery,modified total pelvic floor reconstruction surgery has improved safety through improved puncture points and posterior pelvic floor reconstruction,with fewer surgical complications and low recurrence rate.2.Modified total pelvic floor reconstruction surgery is designed to cut the vaginal "pentagonal" flap,restore the vaginal physiological axis,narrow the vaginal diameter,and extend the length of the vagina,which can better improve the patient’s long-term sexual quality of life.3.Modified total pelvic floor reconstruction surgery has a significant clinical effect on the treatment of moderate to severe pelvic organ prolapse,has a higher anatomical cure rate,and can significantly improve the patient’s subjective and objective satisfaction and quality of life.