Clinical Research Of Surgical Repair For Female Pelvic Floor Dysfunction

Objective: To evaluate the short-term outcomes of the pelvic reconstructive surgery (PRS) for pelvic organ prolapse and the effect of the uterus conservation in the pelvic reconstructive surgery; To investigate the urination conditions in patients after the (PRS)for pelvic organ prolapse(POP),as well as effects of TVT-O used in the operation for urination conditions effect;comparing the anatomic cure rate betweet the anterior pelvic reconstructive surgery and the total pelvic reconstructive surgery.Methods: A retrospective analysis was carried out on 201 women who were admitted in the obstetric and gynecologic department of the Fuzhou General Hospital of Nanjing Millitary during April 2006 to February 2011,who were suffered from pelvic organ prolapse,with or without stress urinary incontinence,accepted the pelvic reconstructive surgeries:157 Gynecare Prolift systems(including 22 anterior pelvic reconstruction surgeries and 135 total pelvic reconstruction surgeries ),35 patients with anterior tranvaginal mesh technique,4 with Gynecare PROSIMA technique (including 1 anterior,2 total and 1 posterior).Other 5 patients underwent PRS without adding any mesh.All the sugeries included 90 cases of uterus conservation,80 with cocommittant hysterectomy and 31 cases with preivous hysterectomy,and 7 with cocommittant TVT-O.There were 10 posterior vaginal colporraphies,2 perineal body colporraphies,12 with PIVS and 2 HUS in the anterior pelvic reconstruction surgeries.Analysing the surgic conditions and the follow-up effects,using the subject symptoms,physical examinations,POP-Q results and questionnaires to evaluate the subject and object cure rate.Results:1,Simple anterior PRS were mainly on anterior vaginal prolapse,and total PRS mainly on anterior and middle pelvic prolapse.Before the surgeries,the POP-Q degree of the uterus/vault prolapse in the total PRS were heavier than the anterior,but there were more POP-Qâ… andâ…¡of posterior vaginal prolapse in the anterior after surgeries, Ap was significantly lower(P=0.000),C changed lower(P=0.699).3,The general clinical characters among the uterus conservation group,cocommittant hysterectomy group and preivous hysterectomy group had no difference. In the uterus conservation group,the surgical time,blood loss,duration of catheterization and the hospitalization days were more less than cocommittant hysterectomy group(P<0.05);The total vaginal length is the shortest.3,PRS alone had the same effective as the PRS and TVT-O(P>0.05), the latter had longer hospitalization days,surgical time and blood loss,de novo SUI is 3.03%.4,The perioperative incidence rate is 9.95%,12% had mesh exposure.The anatomic cure rate was 88.5%,the subject cure rate was 97%,the quality of life greatly changed.Conclusions:1,Pelvic reconstructive surgery had a certain and stable effect,greatly changed the qulity of life;2,Uterus conservation played a role in pelvic reconstructive surgery with a similar result compared with that in concomitant hysterectomy group. Uterus conservation group has shorter operating times and less blood loss which maybe useful in controlling the perioperative risk of the older patients. However,more follow-up is needed to observe the long-term effectiveness and complication.3,Pelvic reconstructive surgery improves significantly the LUTS of POP's patients.It's not necessary to have the cocommittant TVT-O;4,The anterior pevlcic reconstruction surgery was not the best for the patients who had heavier anterior pevlcic prolapse,it had a high reccurence rate in the non-meshed compartments.