THE IMPACT OF DIABETES MELLITUS ON THE EFFECTIVENESS OF SURGICAL TREATMENT OF GENITAL PROLAPSE
Keywords:genital prolapse, type 2 diabetes mellitus, surgical treatment, colpoperineoraphy, colpopexy, sacropexy
The purpose of the study was to optimize the surgical treatment of genital prolapse (GP) in women with diabetes mellitus and to determine its impact on the effectiveness of GP surgical treatment by comparing various modern approaches.
Material and methods. 52 menopausal women with GP of 3–4 degrees were examined. 30 women were diagnosed with type 2 diabetes mellitus (main group) in addition to genital prolapse, 22 women had only GP (comparison group), the control group consisted of 20 menopausal women without signs of GP and type 2 diabetes mellitus. Depending on the method of treatment, the examined women were divided into three groups. The first clinical group included 18 patients (9 women of the main group and 9 patients from the comparison group) who underwent uterus vaginal extirpation, anterior colporrhaphy, colpoperineoraphy. The second clinical group consisted of 20 patients (10 patients from the main group and 10 women from the comparison group) who underwent uterus vaginal extirpation with unilateral sacrospinal fixation of the vagina dome. The third group had 14 women (7 patients from the main group and 7 women from the comparison group), who after vaginal extirpation underwent colpopexy using a polypropylene mesh, which includes polyglycaprolactone.
Results. As a result of the treatment there were 7 recurrences (23.3 %) within 1 year after surgery in the main group. They were 4 cases (44.4 %) after vaginal plastic surgery, 1 (10 %) patient after sacrospinal colpopexy, and 2 (28.6 %) women after using polypropylene mesh, which included polyglycaprolactone. There were 5 recurrences (22.7 %) in the comparison group: 3 (33.3 %) cases were after vaginal plastic surgery, 1 (10 %) woman was after sacrospinal colpopexy, and 1 (14.3 %) patient was after the establishment of a polypropylene mesh, which included polyglycoprolactone. Thus, the most frequent recurrences in women with type 2 diabetes mellitus were after vaginal plastic surgery (44.4 %), but it was more than in women without diabetes (33.3 %). After sacrospinal colpopexy, the recurrence rate was the same (10 %) and the lowest among other surgical treatments. The use of polypropylene mesh, which included polyglycoprolactone, led to complications in 23.3 % of patients with type 2 diabetes mellitus and in 22.7 % of women without extragenital pathology. The obtained data indicate the high efficiency of sacrospinal colpopexy in GP treatment of women with type 2 diabetes mellitus, especially one-sided surgical approach.
Conclusions. Type 2 diabetes mellitus significantly affects the effectiveness of surgical treatment of patients with genital prolapse, increasing the number of postoperative complications. The optimal surgery for genital prolapses in patients with diabetes can be considered a unilateral sacrospinal suspension, which gives the lowest number of recurrences. The use of polypropylene mesh, which includes polyglycaprolactone, is possible in women with type 2 diabetes mellitus, but there is a high probability of rejection and pain. Changes in the endocrine profile of patients with GP and type 2 diabetes mellitus require its correction both in pre- and postoperative periods. The local use of estrogen drugs can be considered optimal for improving the results of surgical treatment and the quality of life of women.
American Diabetes Association. Diabetes Care 2018;41(1): S13-S27. https://doi.org/10.2337/dc18-S002.
Petrov JuA, Kupina AD. Sovremennye problemy nauki i obrazovanija 2020; 2.
Dovgalev RV, Benjuk VA, Nykonjuk TR. Zb. nauk. prac' Asociacii' akusheriv-ginekologiv Ukrai'ny, Kyi'v, 2013:127-131.
Leng B, Zhou Y, Du S, et al. Eur J Obstet Gynecol Reprod Biol 2019;235: 19-25.
Lee UJ, Kerkhof MH, Van Leijsen SA, Heesakkers JP. Curr Opin Urol 2017;27(5): 428-434.
Jacentjuk VV. Zdorov'e zhenshhyny 2015; 5: 59-61, available at: http://nbuv.gov.ua/UJRN/Zdzh_2015_5_14.
Grygorenko AP, Shymans'ka-Gorbatjuk OG, Shatkovs'ka NS, Garbuzjuk VV. Zb.nauk.prac' Asociacii' akusheriv-ginekologiv Ukrai'ny, Kyi'v, 2013: 93-96.
Fleischer K, Thiagamoorthy G. Post Reprod Health 2020; 26(2): 79-85.
Abdool Z, Dietz HP, Lindeque BG. Int Urogynecol J 2017; 28(9): 1387-1391.
Gromyko NL, et al. Reproductive health. Eastern Europe 2017; 7(3): 437-439.
Zhang L, Zheng P, Duan A, et al. Mol Med Rep 2019;19(1): 391-399.
Shkarupa DD, Kubin ND., Popov JeN, et al. Zhurnal akusherstva i zhenskih boleznej 2018;67(3): 55-63.
Caruso S, Cianci S, Vitale SG, et al. Menopause 2017;24(8): 900-907.
Lethaby A, Ayeleke RO, Roberts H. Cochrane Database Syst Rev.2016.
Smith BC, Crisp CC, Kleeman SD, et al. Female Pelvic Med Reconstr Surg 2019;25(2): 93-98.
Aleixo GF, Fonseca MCM, Bortolini MAT, et al. Int Urogynecol J 2019;30(2): 181-190.