UA109201U - METHOD OF TREATMENT OF LITTLE PALASIS PROLAPAS AND URINAL DISEASE IN WOMEN - Google Patents

Abstract

A method of treating pelvic organ prolapse and urinary incontinence in women by performing laparoscopic intervention, fixing the uterus with an implant, and performing the necessary surgery for Burch. First, they cut the uterine round ligaments, retreating 2- from the point of entry of the uterine ligament into the walls of the peritoneum of the lateral walls of the pelvis, then a probe is introduced into the canal of the circular ligaments; clips. Two clips are placed on the uterine circular ligament, deviating from the uterine circular ligament from the uterine body (proximal edge of the ligament), and two clips on the distal edge of the uterine circular ligament, if necessary. fixed in the middle third.

Description

The useful model belongs to medicine, namely surgical gynecology and urology, and can be used in the surgical treatment of pelvic organ prolapse and urinary incontinence in women.

According to world statistics, the frequency of pelvic organ prolapse in women (PPT) reaches 78 95, while the frequency of urinary incontinence (UC) occurs in 50-82 90 cases. This pathology significantly affects the quality of life of women and usually requires surgical intervention.

The main methods of surgical treatment of POMT and its complications in the form of NS are: 1) paraurethral administration of volume-forming drugs, 2) operations with reconstructive plastic surgery of the vagina (with organ loss), 3) correction of the bladder neck, 4) ventrofixation, 5) simultaneous fixation uterus and correction of the bladder neck/urethra. Despite the large number of surgical treatment methods, none of the above-mentioned methods solves this pathology of celluloma, namely - the prolapse of the pelvic organs is eliminated, while urinary incontinence remains; during the correction of urinary incontinence, its cause does not disappear - the prolapse of the pelvic organs, which often leads to a recurrence of incontinence.

In this regard, the trend of treating POMT and NM by performing simultaneous operations, which allow to solve this pathology pathogenetically, has developed. However, simultaneous operations have a number of disadvantages: the high price due to the use of meshes, the occurrence of an autoimmune reaction to a foreign body with the development of a septic condition, which requires repeated surgery to remove the mesh and the search for a new method of treating the pathology, short-term effectiveness of treatment, operations without preserving the organ, which exclude further possibility of pregnancy. All of the above requires the search for new or improvement of already known simultaneous methods of treatment of pelvic organ prolapse and its complication - urinary incontinence.

One of the modern methods of treating prolapse of the pelvic organs and urinary incontinence is sacrocolpopexy. This operation can be performed both laparoscopically and open. When performing laparoscopic vaginopexy, amputation or extirpation of the uterus, pelvic colpopexy according to Vigsy (for stress urinary incontinence), suturing of paravaginal defects can be performed. Sacrocolpopexy is performed using a tezvp system, which is a polypropylene mesh.

There is a known method of laparoscopic sacrocolpopexy, which is performed as follows.

Under endotracheal anesthesia, laparoscopy is performed using three additional trocars. Open the back leaf of the parietal peritoneum above the level of the promontorium.

The latter is allocated to a clear visualization of the transverse presacral ligament. The back sheet of the peritoneum is opened all the way from the promontorium to the Douglas space. The elements of the rectovaginal septum (front wall of the rectum, back wall of the vagina) are distinguished up to the level of the muscles that raise the anus. Mesh prosthesis Z x 15 cm (polypropylene, index zo) is fixed with non-absorbable sutures for the levators on both sides as distally as possible.

Next, the prosthesis is fixed to the cervix (or dome of the vagina in the case of a hysterectomy) with two identical stitches.

At the next stage of the operation, a 3x5 cm mesh prosthesis made of identical material is fixed to the previously mobilized front wall of the vagina and sewn to the previously installed prosthesis in the area of the dome of the vagina or the stump of the cervix. In conditions of moderate tension, the prosthesis is fixed with one or two non-absorbable sutures to the transverse presacral ligament. At the last stage, peritonization is performed. If necessary, they also perform an operation for Birch (Gynecology: national hand. Edited by V.I. Kulakova, I.B. Manukhina, H.M. Savelyeva. - M.: "SZOTAR

MEDIA", 2011. - p. 869). We consider this method a prototype.

Common essential features of the prototype and the claimed utility model are as follows: laparoscopic intervention; fixation of the uterus with the help of an implant, performing, if necessary, an operation according to Burch.

However, this method of treatment has certain disadvantages.

After sacrocolpopexy, quite serious complications may occur: an autoimmune reaction with the development of a purulent-septic process due to rejection of the mesh, a pronounced adhesion process. The frequency of cystocele formation in the postoperative period in patients after sacrocolpopexy with the te5p system in various studies has a wide range (from 1.3 to 92 95) (M. Nepi, M. Oyeyi7, 2008), which often leads to recurrence of urinary incontinence. In addition, the tezvp system itself is quite expensive.

The useful model is based on the task of improving the method of treating prolapse of the pelvic organs and urinary incontinence in women by changing the stages of surgical intervention and the type of implant, which will significantly increase the effectiveness of surgical treatment and avoid complications.

The task is solved by the fact that in the method, which consists in performing a laparoscopic intervention, fixing the uterus with the help of an implant and performing, if necessary, an operation according to Birch, the new thing is that the round ligaments of the uterus are first cut, retreating 2-5 mm from the point of entry of the round ligament of the uterus into the leaves of the parietal peritoneum of the side walls of the small pelvis, then a probe is inserted into the canal of the round ligament, a ureteric catheter is passed through it, which is fixed to the round ligament with clips, while two clips are placed on the round ligament of the uterus , receding 2-5 mm from the departure of the round ligament of the uterus from the body of the uterus (proximal edge of the ligament), and two clips - on the distal edge of the round ligament of the uterus, if necessary, the ligament is fixed in the middle third.

The cause-and-effect relationship between the set of declared signs and the technical result is as follows.

The proposed method of treatment is minimally traumatic, which manifests itself in the form of small blood loss, minimal postoperative pain and rapid (1-2 days) restoration of physiological functions. As a result, the length of stay of patients in the hospital is reduced.

The method is cost-effective (the treatment is cheaper due to the low cost of the material for fixing the ligamentous apparatus, savings on medicines, reduction of the duration of the hospital period and the rehabilitation period of the patient himself).

Operative treatment according to the proposed method makes it possible to combine it with many urological operations, which also makes the treatment of patients with connective diseases less traumatic.

With the proposed method, there is no autoimmune reaction (and subsequently a purulent-septic process) to foreign material. The method is carried out as follows.

Under endotracheal anesthesia, laparoscopy is performed using a camera and 2-3 additional trocars.

The first stage: the round ligaments of the uterus are incised, retreating 2-5 mm from the point of entry of the round ligament of the uterus into the leaves of the parietal peritoneum of the side walls of the pelvis. A probe is inserted into the canal of round ligaments. A ureteral catheter is passed through the probe, which is fixed to the round ligament with clips. Two clips are applied, 2-5 mm away from the departure of the round ligament of the uterus from the body of the uterus (the proximal edge of the ligament), and two clips - on its distal edge (the place of entry of the round ligament of the uterus into the leaves of the parietal peritoneum of the side walls small pelvis). If necessary, the connection is fixed in the middle third. If necessary, the second stage is the Birch operation. Burch's operation (colposuspension) involves fixation of the paraurethral fascia and vaginal wall to Cooper's ligament using non-absorbable suture material.

Example.

Patient B., born in 1971, came in with complaints of leakage of urine when laughing, sneezing, coughing, during physical exertion; feeling of a foreign body in the vagina. The examination was carried out in full. The diagnosis was established: Functional urinary incontinence of the 2nd-3rd degree. Lowering of the pelvic organs. Whole 2 degree. Under anesthesia (ShVLyaev/v), a simultaneous operation was performed as follows. The first stage - the round ligaments of the uterus are incised, departing from the point of entry of the round ligament of the uterus into the leaves of the parietal peritoneum of the side walls of the pelvis by 2-5 mm. A probe was inserted into the canal of round ligaments. A ureteric catheter was passed through the probe, which was fixed to the round ligament with clips. Two clips were applied at the point of departure of the round ligament of the uterus from the body of the uterus (proximal edge of the ligament), and two clips were applied to its distal edge. The second stage was the operation according to bBerch. A urinary catheter was installed. The patient's condition in the postoperative period was stable. The Foley catheter was removed on the 2nd day of the postoperative period. The patient urinated freely, the urine was clear, in sufficient quantity, she noted minor pains during urination that did not require analgesia, she stopped feeling the presence of a foreign body. When sneezing, coughing, laughing, and walking, urine is retained, and the underwear is dry. On the 3-4th day, urination became painless. She was discharged in a satisfactory stable condition. After 3 months, a check-up is recommended. According to the control examination: when sneezing, coughing, laughing, walking for a long time, climbing the stairs, lifting heavy objects - the underwear is dry.

Claims (1)

USEFUL MODEL FORMULA The method of treating prolapse of the pelvic organs and urinary incontinence in women by laparoscopic intervention, fixing the uterus with an implant and, if necessary, performing a Burch operation, which is distinguished by the fact that the round ligaments of the uterus are first incised, retreating 2- 5 mm from the point of entry of the round ligament of the uterus into the leaves of the parietal peritoneum of the side walls of the pelvis, then a probe is inserted into the channel of the round ligament, a ureteric catheter is passed through it, which is fixed to the round ligament with clips, while two clips are placed on round ligament of the uterus, retreating 2-5 mm from the departure of the round ligament of the uterus from the body of the uterus (proximal edge of the ligament), and two clips - to the distal edge of the round ligament of the uterus, if necessary, the ligament is fixed in the middle third.