Genital Prolapse in Pregnant Woman as a Presentation of Aggressive Angiomyxoma: Case Report and Literature Review

Background: Aggressive angiomyxoma is a rare entity within mesenchymal cell neoplasms, especially in pregnant women. Its main characteristic is the ability to infiltrate neighboring structures and to recur. Case Presentation: We present the case of a pregnant woman who debuted with a genital prolapse in the second trimester of pregnancy. She was diagnosed with bilateral ovarian teratomas and a pelvic mass of which the diagnosis could not be established until delivery. The route of delivery used was cesarean section since the genital prolapse behaved as a previous tumor. After the puerperium, the patient was referred for consultation to complete the study of the mass. The extension study was carried out with a negative result. The patient underwent surgery for tumor exeresis. Hormonal treatment was not administered according to the patient’s preferences. Conclusions: Aggressive angiomyxoma is a benign neoplasm that should be considered in the differential diagnosis of pelvic tumors in women. In pregnant women, the vaginal route of delivery is not contraindicated as long as the tumor does not obstruct the birth canal. The definitive treatment is surgery, preferably performed in a second stage after delivery.

Sacrovaginopexy with combined access and mesh-vaginopexy in the treatment of genital prolapse

Comparative analysis of two modem methods of womens genital prolapse treatment was carried out. Comparing close and some remote results of MESH- vaginopexy (97patients) andtransvaginal retroperitonealsacrovaginopexy with laparoscopic control (24 patients), the authors determine particular indications, advantages and expediency of the elaborated methods.

Support role undifferentiated connective tissue dysplasia in genital organ rolapse evolution

Одним из наиболее значимых факторов риска формирования опущений и выпадений внутренних половых органов являются заболевания соединительной ткани. Неуклонный рост числа женщин, страдающих пролапсом органов малого таза, привел к тому, что данная патология стала как медицинской, так и социально-экономической проблемой во многих странах. В то же время данные о роли недифференцированных дисплазий соединительной ткани в развитии пролапса органов малого таза и в формировании недостаточности тазового дна и возможности использования ее с целью прогнозирования данной патологии разноречивы. С целью определения взаимосвязи проявления недифференцированных дисплазий соединительной ткани с развитием пролапса органов малого таза был проведен ретроспективный анализ 157 историй болезни пациенток с пролапсом гениталий. У 27,39% пациенток были отмечены проявления дисплазий соединительной ткани. В 39,53% случаев было выявлено сочетание проявления недифференцированных дисплазий соединительной ткани с родовым травматизмом. У 16,28% от количества случаев с родовым травматизмом и пролапсом органов малого таза выявлены выраженные формы дисплазии соединительной ткани (варикозное расширение вен нижних конечностей, полипоз кишечника, пролапс митрального клапана), потребовавшие хирургической коррекция до беременности или после родов. Выявленная у каждой третьей пациентки, оперированной по поводу несостоятельности тазового дна, недифференцированная дисплазия соединительной ткани позволяет рассматривать ее как фактор риска развития пролапса органов малого таза, особенно в сочетании с травматизацией промежности в родах. Однако для оценки роли и значимости патологии соединительной ткани в прогнозировании формирования опущения и выпадения внутренних половых органов малого таза у женщин необходимы проспективные рандомизированные исследования. One of the most significant risk factors for the formation of internal genital organs is connective tissue diseases. The steady increase in the number of women suffering from pelvic organ prolapse has led to the fact that this pathology has become both a medical and socio-economic problem in many countries. At the same time, the data on the role of undifferentiated connective tissue dysplasias in the development of pelvic organ prolapse and in the formation of pelvic floor insufficiency and the possibility of using it to predict this pathology are contradictory. To determine the relationship between the manifestation of undifferentiated connective tissue dysplasia and the development of pelvic organ prolapse, a retrospective analysis of 157 case histories of patients with genital prolapse was carried out. In 27,39% of patients, manifestations of connective tissue dysplasia were noted. In 39,53% of cases, a combination of the manifestation of undifferentiated connective tissue dysplasias with birth traumatism was revealed. Severe forms of connective tissue dysplasia (varicose veins of the lower extremities, intestinal polyposis, mitral valve prolapse) were found in 16,28% of the number of cases with birth traumatism and pelvic organ prolapse, which required surgical correction before pregnancy or after childbirth. Revealed in every third patient operated on for pelvic floor incompetence, undifferentiated connective tissue dysplasias allows us to consider it as a risk factor for pelvic organ prolapse, especially in combination with perineal trauma during childbirth. However, to assess the role and significance of connective tissue pathology in predicting the formation of prolapse and prolapse of the internal genital organs of the small pelvis in a woman, prospective randomized studies are needed. Keywords: genital prolapse, connective tissue dysplasia, risk factors, social-active age, surgical treatment.

Possibilities of using neodymium laser to improve the condition of vaginal mucosa in women of various ages with initial stages of genital prolapse

Genital prolapse is a sort of epidemic and is registered today in 30% to 56% of women of both reproductive and menopausal ages. Until now, the initial stages of prolapse were not taken into account; as a rule, the correction began immediately with surgical treatment, the results of which were not always satisfactory, and the recurrence rate with plastic correction with one’s own tissues ranged from 37 to 45%. One of the main manifestations of prolapse of the vaginal walls, especially n perimenopause, is vulvovaginal mucosal atrophy, which directly depends on the pH in the vagina. The study is devoted to the analysis of the effectiveness of using neodymium laser to improve the condition of the vaginal mucosa in women of different age groups with initial degrees of genital prolapse. Purpose: scientific substantiation of using neodymium laser in patients of different age groups with grade I–II cysto-rectocele. Material and research methods. Studies were carried out in 69 women aged 31 to 52 years with cysto-rectocele of grade I–II (ICD-10 code N81.6), with the duration of the disease from 4 to 15 years. All patients, depending on their age and the method of treatment used, were divided into 2 groups comparable in terms of clinical and functional characteristics — the main and control groups, each of which had 2 subgroups. In the main group: subgroup 1 included 27 patients of reproductive age with grade I–II cysto-rectocele, who underwent a neodymium laser course with Magic Gyno, consisting of 3 intravaginal procedures with an interval of 28 days; subgroup 2 included 22 patients of perimenopausal and menopausal age with grade I–II cysto-rectocele, who underwent a course of 3 intravaginal procedures with Magic Gyno neodymium laser with an interval of 28 days. The control group included 20 patients with grade I–II cysto-rectocele, who underwent a special complex of exercise therapy; depending on their age, they were also divided into two subgroups: 1 (10 patients) — of reproductive age, 2 (10 patients) — of perimenopausal and menopausal age. The results obtained indicate a pronounced effect of the course application of intravaginal exposure by a neodymium laser on the state of the vulvovaginal mucosa in patients with grade I–II cysto-rectocele, of both reproductive and, most importantly, peri-menopausal age, which was manifested in the normalization of the pH of vaginal discharge and elimination of signs of atrophy of the mucous membrane of the vulva and vagina and was confirmed by the data of pH-metry and the Vaginal Health Index Score. Conclusion. The course use of a neodymium laser in patients of different age groups with grade I–II cysto-rectocele contributes to the formation of a pronounced tropho-stimulating effect, which is manifested in the normalization of the pH of the vaginal discharge and the elimination of signs of atrophy of the mucous membrane of the vulva and vagina.

“Locus minoris resistentiae” and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia

Background Conditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling. Case presentation Three cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general. Conclusion The simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.

Challenges in Diagnosis and Treatment of a Cervical Carcinoma Complicated by Genital Prolapse

Cervical squamous cell carcinoma of the uterus associated with pelvic organ prolapse is very rare and usually occurs in elderly women. We hereby present an 81-year-old postmenopausal woman presented to the outpatient department with an ulcerated irreducible uterine procidentia. The prolapse was reduced under general anesthesia and biopsy of the lesions confirmed a cervical squamous cell carcinoma. Pretreatment clinical staging revealed a 16 cm enlarged uterus and mild to moderate unilateral hydroureteronephrosis, secondary to periureteric infiltration, clinical stage IIIB. The patient was disqualified from surgery, and palliative chemotherapy plus radiotherapy was recommended. Patient’s general condition was rapidly deteriorated, and three months after the diagnosis, the patient passed away. Therapeutic management of cervical cancer associated with uterovaginal prolapse is not well established. Hence, this article presents the clinical concerns that arise in such rare and neglected cases.

Comprehensive management of patients with pelvis organ prolapse and metabolic syndrome

Background. Genital prolapse (GP) and stress urinary incontinence (SUI) are characterized by a failure of connective tissue skeleton of the pelvic floor structures, and there are many risk factors in their pathogenesis. Metabolic syndrome (MS), which includes obesity and abnormalities in the lipid and carbohydrate profile, contributes to the initiation of pelvic organ prolapse (POP) due to increased intra-abdominal pressure and the presence of comorbidities. Endothelial dysfunction associated with MS aggravates the existing metabolic disorders, resulting in the formation of a vicious circle and an increase in the likelihood of recurrence of genital prolapse symptoms and НМ during tension in the postoperative period. Aim. The search for rational algorithms for the comprehensive management of patients with POP and MS. Materials and methods. A comparative analysis of effectiveness of treatment with the use of surgical method or drugs which affect the metabolic profile in patients with GP and SUI was carried out. Results. Drugs which contribute the restoration of lipid and carbohydrate profiles, and microcirculatory vasculature normalization, attenuate negative effects of MS components on the integrity of pelvic floor structures. Comprehensive management of patients with POP and MS with surgical correction of GP and SUI, as well as the use of drugs affecting metabolism, is highly effective and predictive in regard to POP severity and the risk of recurrence of clinical symptoms in the postoperative period. Conclusion. Adequate restoration of the endothelial layer in patients with pelvic floor muscle incompetence and endothelial dysfunction reduces the likelihood of developing mesh-associated complications after the surgical stage of treatment.

Modern approaches to the treatment of genital prolapse in obese women

Introduction. The problem of female genital prolapse (GP) remains in the sportlight of gynecologists, because despite the variety of surgical methods, there are still recurrences of the disease, which are associated not only with the failure of the restored ligaments, fascia, muscles, damaged pelvic floor and perineum, but with the imperfection of the operation. The solution of this problem is especially important in the treatment of patients with extragenital pathology, in particular obesity. The purpose: to optimize the treatment of genital prolapse in obese patients by determining an individual approach to planning surgical treatment taking into account the degree of obesity and concomitant pathology. Materials and methods. We examined 65 patients of which 20 had genital prolapse and obesity (main group), 25 had genital prolapse and normal weight (comparison group), 20 women did not have gynecological diseases and extragenital pathology made up control group. To diagnose obesity and determine its degree we calculated body mass index (BMI). To determine the degree of GP its quantitative assessment was used (POP-Q; 1996). Surgical intervention included transvaginal extirpation of the uterus without appendages, anterior colporrhaphy, colpoperineoraphy with levatoplasty, sacrospinal colpopexy. Transabdominal and laparoscopic colposacropexy in obese women were not used due to the presence of relative contraindications for laparoscopy (cardiovascular disease, respiratory pathology, adhesions, the condition after hernias’ surgery). Therefore, all operations on women with GP and obesity were performed transvaginally due to the inability to perform abdominal access. In comparison group transvaginal surgery was performed. All the groups under study were representative. Before the use of polypropylene mesh "Polymesh" to minimize purulent-septic complications associated with the use of synthetic prostheses aquadissection was performed with 0.9% saline with the addition of 1 g of ceftriaxone per 200 ml. After the operation, the women used suppositories with hyaluronic acid (revitax). Results. The results of surgical treatment have been analyzed and the following data were obtained: recurrences in the main and in the comparison group were 4% (2 women in whom operations were performed with the use of their own tissues without mesh prosthesis). Infectious complications, dyspareunia and pelvic pain were not observed. Conclusions. Surgical treatment of GP in obese women by using polypropylene mesh "Polymesh" for colposacropexy after transvaginal uterine extirpation increases the effectiveness of treatment and redduces the number of recurrences. Hydropreparation of the mesh with an antibacterial agent and postoperative use of hyaluronidase intravaginally helps to reduce purulent-septic complications of surgery and improves the patients’quality of life.