Комбіновані методи лікування жінок із нетриманням сечі при напруженні, асоційованим із генітальним пролапсом

Abstract

Целью исследования была оценка эффективности комбинированных методов лечения женщин с недержанием мочи при напряжении, ассоциированном с генитальным пролапсом. Показано, что предложенный комбинированный способ лечения больных с генитальным пролапсом имеет высокую клиническую эффективность. В частности, применение комплексного метода оперативного лечения стрессового недержания мочи, ассоциированного с генитальным пролапсом, имело более выраженное влияние на показатели величины заднего пузырно-уретрального угла: до операции — (137,1±4,7)° в покое, (167,7±3,3)° — при напряжении, после операции — (100,8±2,9)° в покое, (117,3±3,2)° — при напряжении.

The most of the interventions carried out for the correction of stress urinary incontinence are aimed at reducing hypermobility of vesico-urethral segment by the means of a physiological mechanism consisting of muscles and ligaments of pelvic floor or increase of urethral resistance. The study was aimed to evaluate the effectiveness of combined treatments for women with stress incontinence associated with genital prolapse. The research was conducted at the ONMedU Center for Reconstructive Medicine. From 2011 to 2012 there were operated 33 women with genital prolapse and incontinence. All patients underwent examination in accordance with current clinical protocol, approved by the Ministry of Health N 330 from 15.06.2007. Treatment of all patients started on a course of training, perineal muscles using the method of biofeedback as a method of first-line treatment of the incontinence. Then 15 women were operated with the frontal and posterior colporrhaphy and urethrovesiculoplastics, the rest 18 women were operated with TVT (tension free tape) with the inclusion phase lipografting. It is shown that the proposed combined method of treatment of patients with genital prolapse has high clinical efficacy. The integrated method for surgical treatment of stress urinary incontinence associated with genital prolapse had a more pronounced effect on the performance value urethovesical angle (before surgery — (137.1±4.7)°, (167.7±3.3)° — with straining after the surgery — (100.8±2.9)° alone, (117.3±3.2)° — with tension). Thus, the combined method of treatment leads to the normalization of the anatomy of urethrovesical segment and proximal urethra, restoring a sphincter mechanism.