外科ジャーナル

Current Possibilities of Treatment in Pelvic-Perineal Floor Dysfunctions

Abstract

Simona Niculescu, Ana Maria En�?�??�?�?chescu, Dan Niculescu and Mircea Onofriescu

To support through personal experience the use on a large scale of the modern techniques of correction of the pelvic floor disorders by using polypropylene prosthetic devices. Objectives: To specify the technical details regarding the correct placement of prostheses in feminine genital prolapse. Show the personal casuistry in order to highlight the indications techniques and results of these types of surgeries. Plead for expending the modern techniques in pelvic-perineal floor dysfunctions. Material and Methods: The study was performed between July 2007 and July 2013, in the second surgical Clinic St.Spiridon Hospital Iasi, on 138 cases with different pelvic floor dysfunctions. Different procedures were practiced, isolated or associated, on the patients in the lot, depending on symptoms, the prolapse type and degree, age, local anatomical situation and the existence or absence of sexual life. Thus they were performed: strip urethrocystopexy or “hammock” device, with four arms transobturator - 68 cases; The sacrosciatic posterior colposuspension or the anal levator floor restoration–29 cases; abdominal colpopexy in 41 cases, 18 of which with hysterectomy or resection of residual cervix. In 5 cases a polypropylene mesh implant has been associated with this procedure at anal levator level; and in 11 cases the doctors used a suburethral transobturator vaginal strip for stress urinary incontinence (SUI). The abdominal approach allows the correct path of skeletonization of the internal genitalia and also of the vagina which is turned inside-out like a glove finger, avoiding damage on the ureters and bladder. The vaginal vault is secured to the promontory with a polypropylene device and it ensures the results maintain in time. Results: The treatment of the different pelvic-perineal floor disorders that are associated or not with stress urinary incontinence has benefited lately from new indications and techniques by using different prosthetic devices made of polypropylene, which are especially conceived and placed through minimally invasive procedures. Generally, all the cases had an immediate simple postoperatory evolution with only two haematomas that required surgical evacuation and 3 cases of vaginal mucosa necrosis, one of them requiring the removal of the device implanted. The anatomical and functional results were good. Conclusions: The use of strips, nets and polypropylene devices in correcting different pelvic floor disorders, shows certain advantages, as it is relatively easy tom implement, the hospitalization period is shortened and there are very good results that pass the test of time.