Simultaneous operations in urogynecology

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The objective. Investigation of genital and extragenial pathology in women with stress-induced enuresis (SE) and estimation of the possibility of using simultaneous operations in surgical treatment.

Material and methods. At the period from 2000 to 2003 in N. I. Pirogov Saint-Petersburg Multifield Clinic 59 patients were operated on for SE. TVT sling operations were carried out in 31 female patients (the 1^st group). The worked out method of pubovaginal sling operation with prolen net was applied in 28 female patients (the 2^nd group). The age of women varied from 31 to 66 (on average 47,1 years old) in the 1^st group and from 37 to 74 (on average 52,7 years old). Complex system of patient examination (USE, CUDE, MRT, endoscopic, clinical and statistical methods) was used for postoperative diagnostics and control.

Results. Various extragenital diseases were found in 18 (64,2%) patients from the 1st group and in 23 (74,2%) in the 2^nd group. Combination of SE with various vaginal wall deviations, urinary bladder and rectum dispositions was recorded in 23 (82,1%) patients from the 1st group and in 27 (87%) patients in the 2^nd group. Different pathology of inner genitals was revealed in 20 (71,4%) patients from the 1^st group and in 15 (48,3%) patients from the 2^nd group. Other surgeries aimed at elimination of inner genitals ptosis, inner genitals pathology and pelvic floor restoration were performed simultaneously with surgical correction of SE. In 24 (85,7%) patients from the 1^st group the following 29 operations were performed: anterior colporrhaphy, posterior colpoperineorrhaphy with levatoroplasty in 14 (48,3%), anterior colporrhaphy in 9 (31%), laparoscopic and laparatomic conservative myomectomy in 2 (6,9%), laser vaporization of the cervix of the uterus in 2 (6,9%), hysteroscopy and diagnostic curettage of uterine cavity in 1 (3,4%), hemorrhoidectomy in 1 (3,4%) patients. In 27 (87,1%) patients from the 2^nd group the following 37 operations were performed: anterior colporrhaphy, posterior colpoperineorrhaphy with levatoroplasty in 15 (40.5%), anterior colporrhaphy in 12 (32,4%), hysteroscopy and diagnostic curettage of uterine cavity in 4 (10,8%), Manchester operation in 2 (5,4%), elimination of ventral hernia and omphalocele in 2 (5,4%), vaginal hysterectomy in 1 (2,7%), laser vaporization of the cervix of the uterus in 1 (2,7%) patients.

Conclusion. High frequency of concomitant diseases with different variants of pelvic organs prolapse predominant is recorded in patients with SE. Combination of SE, genitals prolapse, varicose veins, abdominal hernia, biliary dyskinesia, nephroptosis, hemorrhoids may result from system connective tissue deficiency. The found inner genitals pathology demands considerable expansion of surgical operation. Surgical correction of SE with the use of both sling operations with prolen net is possible in combination with any extent of surgical operation in women. Sling operations can be carried out independently or as a stage of simultaneous surgical treatment.

About the authors

Р. A. Rykin

Saint Petersburg Multidisciplinary Clinic named after N.I. Pirogov

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Saint-Petersburg

S. В. Singaevskiy

Saint Petersburg Multidisciplinary Clinic named after N.I. Pirogov

Email: info@eco-vector.com
Russian Federation, Saint-Petersburg

В. К. Komyakov

Petersburg State Medical Academy named after I.I. Mechnikov

Email: info@eco-vector.com
Russian Federation, Saint-Petersburg

V. N. Kustarov

Saint Petersburg Medical Academy of Postgraduate Education

Email: info@eco-vector.com
Russian Federation, Saint-Petersburg

А. V. Borisov

Saint Petersburg Medical Academy of Postgraduate Education

Email: info@eco-vector.com
Russian Federation, Saint-Petersburg

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