Evaluation Of Curative Effect Of Surgical Treatment Of Pelvic Organ Prolapse In Moderate And Severe Women

BackgroundFemale Pelvic Floor functional disorders(PFD),caused by degradation,injury and dysfunction of the pelvic support tissue,including mainly Stress Urinary Incontinence(SUI),Pelvic Organ Prolapse(POP),Sexual Dysfunction(SD),Fecal Incontinence(FI),etc.Of which POP and SUI are most common.POP occurs in women of all ages,but the incidence is highest among the elderly.According to the location of prolapse,POP can be divided into genital prolapse(prolapse of the anterior or the posterior wall of vagina and uterine prolapse),bladder prolapse,rectal prolapse,rectal hernia or vaginal dome prolapse after hysterectomy,etc.With the development of the society,people's pursuit of high quality of life and the increasing aging of the social population,the incidence of POP in women is increasing year by year.The treatment regimens of POP including non-surgical treatment regimens and surgical treatment regimens.The non-surgical treatment regimens are mainly for patients with mild and moderate POP without severe complications,and the surgical treatment regimens are mainly for patients with moderate and severe symptoms of POP,patients that failed in non-surgical treatment and mild patients with severe complications.There are a wide range of surgical options,and the most commonly used in clinical practice mainly include transvaginal total hysterectomy+pelvic floor reconstruction surgery,laparoscopic total hysterectomy+sacrocolpopexy,and transvaginal mesh(TVM).However,there are few studies on the comparison and comprehensive evaluation of the curative effect of these certain surgical treatment on pop in moderate and severe women.Objective1.To investigate the safety and efficacy of different surgical methods in the treatment of patients with moderate and severe pelvic organ prolapse.2.To discuss the etiology and risk factors of pelvic organ prolapse and summarize the treatment regimens of pelvic organ prolapse,to provide a comprehensive understanding and consideration for the treatment of this diseaseMethods1.Objects of study and groupings:A retrospective analysis was conducted on 170 patients who received surgical treatment for moderate and severe pelvic organ prolapse in the department of obstetrics and gynecology,qilu hospital,shandong university,from January 2015 to January 2018.They were divided into three groups according to the different surgical methods.108 patients in group A received transvaginal total hysterectomy+pelvic floor reconstruction surgery,42 patients in group B received laparoscopic total hysterectomy+sacrocolpopexy and 20 patients in group C received TVM.2.Inclusion and exclusion criteria(1)patients with pelvic organ prolapse in POP-Q stage ?-?(Figure 1,Table 1 and Table 2);(2)patients that were informed fully and volunteered to participate in the research process;(3)clinical data and follow-up data of the patients are complete;(4)patients with previous history of abdominal surgery were excluded;(5)non-primary operation patients and patients whose surgical methods were not consistent with the above three groups were excluded;(6)patients with communication barriers such as history of mental illness and cerebral infarction were excluded;(7)patients with combined malignant tumors and patients with newly discovered postoperative diseases affecting the evaluation of surgical efficacy of prolapse were excluded.3.Collection of clinical dataBasic clinical data of the included patients were collected by consulting the electronic medical record system of our hospital,mainly including:age,parity,history of giant childbirth,body mass index(BMI),menopausal status,POP-Q staging,history of pelvic surgery,preoperative complications(diabetes,hypertension,coronary heart disease,etc.),operative time,total cost of hospitalization,total hospitalization days,perioperative complications(intraoperative adjacent organs injury,intraoperative bleeding and postoperative intestinal obstruction,lower extremity deep venous thrombosis after operation,urinary retention,dysuria,etc.)4.Postoperative follow-up program of POP patientsLong-term postoperative complications and postoperative quality of life scores were collected by outpatient follow-up or telephone follow-up,mainly including hypogastralgia,stress urinary incontinence,rectal dysfunction,mesh exposure,mesh erosion,recurrence of prolapse,etc.We guided the patients to complete the PFDI-20 questionnaire,the score of life quality was gained according to the questionnaire results5.Statistics processSPSS 24.0 software was used for statistical analysis of the data of the research objects,analysis of variance was used to compare the measurement data involved in the study and the results were expressed as mean±standard deviation.Chi-square test was used to compare the counting data involved in the study.All the statistical studies involved took either P=0.05 as the test level,and when P<0.05,the difference between the studies was considered to be statistically significant.Results1.Analysis on pre-operative clinical dataTotally 170 patients with moderate and severe pelvic organ prolapse were included,they were divided into three groups according to the different surgical methods.108 patients in group A received transvaginal total hysterectomy+pelvic floor reconstruction surgery,42 patients in group B received laparoscopic total hysterectomy+sacrocolpopexy and 20 patients in group C received TVM.On analysis of pre-operative clinical data(Figure 3),age:64.39±8.16 years old for group A,53.81 ±7.22 years old for group B,61.70±7.88 years old for group C;BMI:24.76±22.81 Kg/m2 for group A,25.45±3.08 Kg/m2 for group B,27.96±2.49 Kg/m2 for group C;Parity:2.44± 1.19 times for group A,1.62±0.80 times for group B,2.40±1.67 times for group C;History of giant childbirth;6.48%(7/108)for group A,19.05%(8/42)for group B,0.00%(0/20)for group C;Menopausal status:91.67%(99/108)for group A,57.14%(24/42)for group B,85.00%(17/20)for group C;History of hypertension:46.30%(50/108)for group A,19.05%(8/42)for group B,30.00%(6/20)for group C.We found that there existed statistical difference in the age,BMI,parity,history of giant childbirth,menopausal status and history of hypertension among these three groups(P<0.05),however,the difference of the history of diabetes,chronic cough,chronic constipation and pelvic surgery among the three groups were not statistically significant(P>0.05).2.Analysis on the preoperative pelvic organ prolapse level,POP-Q stagingOn analysis of pelvic organ prolapse level(Figure 4),group A:12.04%(13/108)was of POP-Q ? stage,57.41%(62/108)was of POP-Q ? stage,30.56%(33/108)was of POP-Q ? stage;group B:4.76%(2/42)was of POP-Q ? stage,52.38%(22/42)was of POP-Q ? stage,42.86%(18/42)was of POP-Q? stage;group C:10.00%(2/20)was of POP-Q ? stage,55.00%(11/20)was of POP-Q ? stage,35.00%(7/20)was of POP-Q ? stage.It was found that there was no statistic al difference in preoperative prolapse level among the three groups(P>0.05)3.Analysis on perioperative clinical dataOn analysis of perioperative clinical data(Figure 5),intraoperative blood loss:102.59±25.85 ml in group A,175.48±29.67 ml in group B,161.50±34.15 ml in group C;Operation time:59.26±8.08 min in group A,102.98±8.84 min in group B,82.30±8.46 min in group C;Length of hospitalization:7.00±0.97 days for group A,7.90±0.79 days for group B,8.95± 1.10 days for group C.It was found that there was statistical significance in the difference of intraoperative blood loss,operation time,length of hospitalization and total hospital expenses(P<0.05),but there was no statistically significant difference in the number of postoperative indwelling catheter days and the time of postoperative anal exhaust among the three groups(P>0.05).4.Analysis on postoperative long-term complications and score of life quality.On analysis of postoperative long-term complications and score of life quality(Figure 6),rate of postoperative recurrence:11.11%(12/108)for group A and none for either group B or group C;Postoperative urinary incontinence:17.59%(19/108)for group A,28.57%(12/42)for group B,20.00%(4/20)for group C;Rectal dysfunction:23.15%(25/108)for group A,28.57%(12/42)for group B,10.00%(2/20)for group C.We found that there was a statistical difference between the rate of postoperative recurrence(P<0.05),but the differences in the rates of postoperative urinary incontinence,rectal dysfunction and life quality score of the three groups were not statistically significant(P>0.05).In addition,two patients in group B had mesh exposure after surgery,while none occurred in group C,but the difference between the two groups was not statistically significant(P>0.05)Conclusions1.Age,body mass index,frequency of vaginal delivery,history of macrosomia,menopausal status,and history of hypertension were the factors that affected the choice of surgical options for moderate and severe POP patients.2.Transvaginal total hysterectomy+pelvic floor reconstruction surgery,laparoscopic total hysterectomy+sacrocolpopexy and TVM are all effective surgical regimens for the treatment of moderate and severe pelvic organ prolapse patients in women,and there is no significant difference in the quality of life after treatment.3.Patients who received transvaginal total hysterectomy+pelvic floor reconstruction surgery had a relatively shortest operation time,least intraoperative blood loss and shortest length of hospitalization with a relatively high post-operative recurrent rate,however.Patients who received laparoscopic total hysterectomy and sacrocolpopexy had the highest operative time and intraoperative blood loss,and a relatively higher risk of postoperative mesh exposure.InnovationsEvaluation of curative effect of surgical treatment of pelvic organ prolapse in moderate and severe women were compared and the factors influencing the choice of POP treatment regimen were discussed,playing a guiding role for clinical work,making fundament for the subsequent large sample prospective cohort study.LimitationsThis study belonged to retrospective analysis with a small sample size,there existed recall bias and selction bias which may affect the objectivity and repeatability of the conclusions.Sample size enlargement,follow-up time prolongment and multicenter analysis were required for subsequent research.