Early and late outcomes of different methods of surgical correction of grade II–III anterior vaginal wall prolapse

Objective. To compare the early and late outcomes of surgical correction of grade II-III anterior vaginal wall prolapse using own tissues, polypropylene and titanium mesh implants in various modifications. Patients and methods. The study included 128 patients in the reproductive, pre- and postmenopausal periods with grade II–III anterior vaginal wall prolapse (AVWP), who were divided into four clinical groups depending on the surgical technique performed. Group Ia (study group) included 34 patients who underwent surgical correction of grade II-III AVWP using titanium mesh implants and suture anchors according to the developed original technique, group Ib consisted of 29 patients who underwent the modified proposed technique, group II (comparison) – 30 women with polypropylene mesh implants, group III (comparison) – 35 patients after anterior colporrhaphy with their own tissues. Surgical results in the early and late postoperative periods (at 1, 6, 12, 24, 36 months) were analyzed. The efficacy of surgical treatment was evaluated by questionnaires and dynamic monitoring, including pelvic examination with the Valsalva maneuver, transperineal and transvaginal ultrasound. Results. During 1 month after surgery, almost every second patient in the four clinical groups reported irregular nagging pain in the perineum, lumbosacral and/or inguinal regions. Frequent urination was observed in 20.6%; 20.7%; 23.3%; 20% of patients in groups Ia, Ib, II, III, respectively. Further questionnaire of the majority of patients in groups Ia, Ib, II, III showed satisfaction with the results of surgical treatment, which had a positive effect on the quality of life of women. However, during the dynamic follow-up, 13.3% of patients in group II were diagnosed with mesh extrusion after 6–12 months, which required its excision. Genital prolapse recurrence in the late postoperative period was detected in 5.9%, 6.7%, 22.85% of patients in groups Ia, II, III, respectively. Conclusion. This study demonstrates the advantages of using multifocally fixed trapezoidal-shaped mesh titanium endoprostheses of individual sizes for the correction of grade II–III AVWP and prevention of postoperative cervical prolapse compared to other surgical methods of treatment of this pathology. Key words: grade II–III anterior vaginal wall prolapse, surgical correction, titanium and polypropylene mesh implants, reproductive, pre- and postmenopausal periods, mesh-associated complications, recurrences