Frontiers in surgery · 2026
Pelvic floor biomechanical reconstruction for moderate to severe pelvic organ prolapse: two-year outcomes of anatomical restoration and urinary continence.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shen Jihong, Yang Xunguo, Gao Zhenhua, Li Ling, Tian Daoming, Li Yuan, Gu Jiangna, Li Hongcheng, Luo Qian, Wang Xingqi
Аннотация
OBJECTIVE: To evaluate the anatomical restoration, changes in urinary control function, and safety of pelvic floor biomechanical reconstruction in patients with moderate to severe pelvic organ prolapse (POP).
MATERIALS AND METHODS: This retrospective study analyzed the clinical data of 135 patients with POP-Q stage ≥ III who underwent pelvic floor biomechanical reconstruction between January 2022 and December 2023. Based on preoperative symptoms and urodynamics, patients were classified as occult stress urinary incontinence (OSUI, n = 32), no SUI with negative urodynamics (n = 41), and clinically confirmed SUI (n = 62). Follow-up assessments were conducted at 3 months, 1 year, and 2 years postoperatively. Outcomes included POP-Q indicators (Aa, Ba, C, D, Ap, Bp, Gh, Pb, TVL), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Patient Global Impression of Improvement (PGI-I). Transperineal three-dimensional ultrasound was performed preoperatively and at 3 months postoperatively to measure the urethral rotation angle (URA), retrovesical angle (RVA), bladder neck descent (BND), and levator hiatus area (LHA). Perioperative and follow-up complications, POP recurrence, and SUI outcomes were also recorded.
RESULTS: All procedures were completed successfully. All POP-Q indicators improved significantly at 3 months, 1 year, and 2 years compared with baseline (all P < 0.001). At 3 months, ultrasound parameters decreased significantly (URA 81.5 ± 25.9° to 38.0 ± 13.7°; RVA 164.7 ± 19.5° to 106.9 ± 18.9°; BND 37.1 ± 13.3 to 12.7 ± 6.6 mm; LHA 30.7 ± 5.2 to 17.2 ± 4.8 cm2; all P < 0.05). PFDI-20 scores decreased from 144.6 ± 44.5 preoperatively to 52.1 ± 21.3 (3 months), 13.7 ± 11.1 (1 year), and 8.1 ± 8.5 (2 years) (P < 0.001). At 2 years, 94.8% of patients reported "very much improved" or "much improved". Overall postoperative SUI symptom rate was 3.7%. POP recurrence occurred in 2.2%. Major adverse events were uncommon: intraoperative complications 3.0% and mesh exposure 1.5%.
CONCLUSION: Pelvic floor biomechanical reconstruction provides durable anatomical correction with favorable continence outcomes and low recurrence, with manageable morbidity.
MATERIALS AND METHODS: This retrospective study analyzed the clinical data of 135 patients with POP-Q stage ≥ III who underwent pelvic floor biomechanical reconstruction between January 2022 and December 2023. Based on preoperative symptoms and urodynamics, patients were classified as occult stress urinary incontinence (OSUI, n = 32), no SUI with negative urodynamics (n = 41), and clinically confirmed SUI (n = 62). Follow-up assessments were conducted at 3 months, 1 year, and 2 years postoperatively. Outcomes included POP-Q indicators (Aa, Ba, C, D, Ap, Bp, Gh, Pb, TVL), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Patient Global Impression of Improvement (PGI-I). Transperineal three-dimensional ultrasound was performed preoperatively and at 3 months postoperatively to measure the urethral rotation angle (URA), retrovesical angle (RVA), bladder neck descent (BND), and levator hiatus area (LHA). Perioperative and follow-up complications, POP recurrence, and SUI outcomes were also recorded.
RESULTS: All procedures were completed successfully. All POP-Q indicators improved significantly at 3 months, 1 year, and 2 years compared with baseline (all P < 0.001). At 3 months, ultrasound parameters decreased significantly (URA 81.5 ± 25.9° to 38.0 ± 13.7°; RVA 164.7 ± 19.5° to 106.9 ± 18.9°; BND 37.1 ± 13.3 to 12.7 ± 6.6 mm; LHA 30.7 ± 5.2 to 17.2 ± 4.8 cm2; all P < 0.05). PFDI-20 scores decreased from 144.6 ± 44.5 preoperatively to 52.1 ± 21.3 (3 months), 13.7 ± 11.1 (1 year), and 8.1 ± 8.5 (2 years) (P < 0.001). At 2 years, 94.8% of patients reported "very much improved" or "much improved". Overall postoperative SUI symptom rate was 3.7%. POP recurrence occurred in 2.2%. Major adverse events were uncommon: intraoperative complications 3.0% and mesh exposure 1.5%.
CONCLUSION: Pelvic floor biomechanical reconstruction provides durable anatomical correction with favorable continence outcomes and low recurrence, with manageable morbidity.