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Опыт консервативного лечения пролапса гениталий с помощью урогинекологических пессариев
Опыт консервативного лечения пролапса гениталий с помощью урогинекологических пессариев
Ярин Г.Ю., Вильгельми И.А., Люфт E.В. Опыт консервативного лечения пролапса гениталий с помощью урогинекологических пессариев. Гинекология. 2019; 21 (4): 24–26.
DOI: 10.26442/20795696.2019.4.190228
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Аннотация
Актуальность. Пролапс тазовых органов является одним из наиболее распространенных заболеваний среди женщин во всем мире. Среди женщин в возрасте старше 50 лет заболеваемость в среднем составляет 41%. Методов лечения пролапса гениталий существует довольно много, они делятся на хирургические и нехирургические. Одним из методов консервативного лечения является использование пессариев. Эффективность терапии пессариями, по данным разных исследований, составляет приблизительно 60%.
Цель. Оценить безопасность и эффективность консервативного лечения пролапса гениталий с использованием кубического пессария на основании стандартизированных опросников.
Материалы и методы. В Центре урологии и гинекологии АНО «Клиника НИИТО» за период с августа 2015 г. по март 2016 г. было установлено 26 пессариев женщинам с разной степенью пролапса гениталий. Оценивались эффективность использования пессариев, удовлетворенность пациенток данным методом лечения, количество осложнений.
Выводы. Использование урогинекологического кубического пессария в лечении разных типов пролапса гениталий является достаточно эффективным методом (р<0,05).
Заключение. Для определения безопасности и эффективности долговременной терапии необходимо проведение дальнейших исследований.
Ключевые слова: пролапс гениталий, пессарий, лечение пролапса гениталий.
Aim. To estimate a safety and efficacy of genital prolapse conservative treatment with a cube pessary on the basis on standardized questionnaires.
Materials and methods. In “NRITO Clinic” Urology and Gynecology Center 26 women with various degree genital prolapse were treated with pessary within the period from august 2015 to march 2016. Efficacy of pessaries use, patient satisfaction with this treatment method and complications rate were estimated.
Results. Urogynecological cube pessary use in a treatment of various types of genital prolapse is quite an effective method (p<0.05).
Conclusion. Further studies are required to determine a safety and efficacy of long-term pessary therapy.
Key words: genital prolapse, pessary, treatment of genital prolapse.
Цель. Оценить безопасность и эффективность консервативного лечения пролапса гениталий с использованием кубического пессария на основании стандартизированных опросников.
Материалы и методы. В Центре урологии и гинекологии АНО «Клиника НИИТО» за период с августа 2015 г. по март 2016 г. было установлено 26 пессариев женщинам с разной степенью пролапса гениталий. Оценивались эффективность использования пессариев, удовлетворенность пациенток данным методом лечения, количество осложнений.
Выводы. Использование урогинекологического кубического пессария в лечении разных типов пролапса гениталий является достаточно эффективным методом (р<0,05).
Заключение. Для определения безопасности и эффективности долговременной терапии необходимо проведение дальнейших исследований.
Ключевые слова: пролапс гениталий, пессарий, лечение пролапса гениталий.
________________________________________________
Aim. To estimate a safety and efficacy of genital prolapse conservative treatment with a cube pessary on the basis on standardized questionnaires.
Materials and methods. In “NRITO Clinic” Urology and Gynecology Center 26 women with various degree genital prolapse were treated with pessary within the period from august 2015 to march 2016. Efficacy of pessaries use, patient satisfaction with this treatment method and complications rate were estimated.
Results. Urogynecological cube pessary use in a treatment of various types of genital prolapse is quite an effective method (p<0.05).
Conclusion. Further studies are required to determine a safety and efficacy of long-term pessary therapy.
Key words: genital prolapse, pessary, treatment of genital prolapse.
Полный текст
Список литературы
1. Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (3): 437–40.
2. Hendrix SL, Clark A, Nygaard I et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186 (6): 1160–6.
3. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1037–45.
4. Swift S, Woodman P, O'Boyle A et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192 (3): 795–806.
5. Drutz HP, Alarab M. Pelvic organ prolapse: demographics and future growth prospects. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (Suppl. 1): S6–9.
6. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 2001; 184 (7): 1496–501.
7. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007; 369: 1027–38.
8. Lin SY, Tee YT, Ng SC et al. Changes in the extracellular matrix in the anterior vagina of women with or without prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (1): 43–8.
9. Bump RC, Mattiasson A, Bø K et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175 (1): 10–7.
10. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev 2013; 2.
11. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011; 12.
12. Bash KL Review of vaginal pessaries. Obstet Gynecol Surv 2000; 55 (7): 455–60.
13. Cundiff GW, Amundsen CL, Bent AE et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol 2007; 196 (4): 405.e1–8.
14. Ramsay S, Tu LM, Tannenbaum C. Natural history of pessary use in women aged 65–74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J 2016; 12.
15. Milart P, Woźniakowska E, Czuczwar P, Woźniak S. Pelvic organ prolapse in women: how is it diagnosed and treated currently? Prz Menopauzalny 2015; 14 (3): 155–60.
2. Hendrix SL, Clark A, Nygaard I et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186 (6): 1160–6.
3. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1037–45.
4. Swift S, Woodman P, O'Boyle A et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192 (3): 795–806.
5. Drutz HP, Alarab M. Pelvic organ prolapse: demographics and future growth prospects. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (Suppl. 1): S6–9.
6. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 2001; 184 (7): 1496–501.
7. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007; 369: 1027–38.
8. Lin SY, Tee YT, Ng SC et al. Changes in the extracellular matrix in the anterior vagina of women with or without prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (1): 43–8.
9. Bump RC, Mattiasson A, Bø K et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175 (1): 10–7.
10. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev 2013; 2.
11. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011; 12.
12. Bash KL Review of vaginal pessaries. Obstet Gynecol Surv 2000; 55 (7): 455–60.
13. Cundiff GW, Amundsen CL, Bent AE et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol 2007; 196 (4): 405.e1–8.
14. Ramsay S, Tu LM, Tannenbaum C. Natural history of pessary use in women aged 65–74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J 2016; 12.
15. Milart P, Woźniakowska E, Czuczwar P, Woźniak S. Pelvic organ prolapse in women: how is it diagnosed and treated currently? Prz Menopauzalny 2015; 14 (3): 155–60.
2. Hendrix SL, Clark A, Nygaard I et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186 (6): 1160–6.
3. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1037–45.
4. Swift S, Woodman P, O'Boyle A et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192 (3): 795–806.
5. Drutz HP, Alarab M. Pelvic organ prolapse: demographics and future growth prospects. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (Suppl. 1): S6–9.
6. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 2001; 184 (7): 1496–501.
7. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007; 369: 1027–38.
8. Lin SY, Tee YT, Ng SC et al. Changes in the extracellular matrix in the anterior vagina of women with or without prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (1): 43–8.
9. Bump RC, Mattiasson A, Bø K et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175 (1): 10–7.
10. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev 2013; 2.
11. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011; 12.
12. Bash KL Review of vaginal pessaries. Obstet Gynecol Surv 2000; 55 (7): 455–60.
13. Cundiff GW, Amundsen CL, Bent AE et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol 2007; 196 (4): 405.e1–8.
14. Ramsay S, Tu LM, Tannenbaum C. Natural history of pessary use in women aged 65–74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J 2016; 12.
15. Milart P, Woźniakowska E, Czuczwar P, Woźniak S. Pelvic organ prolapse in women: how is it diagnosed and treated currently? Prz Menopauzalny 2015; 14 (3): 155–60.
________________________________________________
2. Hendrix SL, Clark A, Nygaard I et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186 (6): 1160–6.
3. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1037–45.
4. Swift S, Woodman P, O'Boyle A et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192 (3): 795–806.
5. Drutz HP, Alarab M. Pelvic organ prolapse: demographics and future growth prospects. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (Suppl. 1): S6–9.
6. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 2001; 184 (7): 1496–501.
7. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007; 369: 1027–38.
8. Lin SY, Tee YT, Ng SC et al. Changes in the extracellular matrix in the anterior vagina of women with or without prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (1): 43–8.
9. Bump RC, Mattiasson A, Bø K et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175 (1): 10–7.
10. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev 2013; 2.
11. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011; 12.
12. Bash KL Review of vaginal pessaries. Obstet Gynecol Surv 2000; 55 (7): 455–60.
13. Cundiff GW, Amundsen CL, Bent AE et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol 2007; 196 (4): 405.e1–8.
14. Ramsay S, Tu LM, Tannenbaum C. Natural history of pessary use in women aged 65–74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J 2016; 12.
15. Milart P, Woźniakowska E, Czuczwar P, Woźniak S. Pelvic organ prolapse in women: how is it diagnosed and treated currently? Prz Menopauzalny 2015; 14 (3): 155–60.
Авторы
Г.Ю. Ярин*1,2, И.А. Вильгельми1,2, E.В. Люфт2
1. ФГБУ «Новосибирский научно-исследовательский институт травматологии и ортопедии им. Я.Л. Цивьяна» Минздрава России, Новосибирск, Россия;
2. АНО «Клиника травматологии, ортопедии и нейрохирургии НИИТО», Новосибирск, Россия
*yaringennadiy@icloud.com
1. Tsivian Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia;
2. Clinic of Traumatology, Orthopedics and Neurosurgery of NRITO, Novosibirsk, Russia
*yaringennadiy@icloud.com
1. ФГБУ «Новосибирский научно-исследовательский институт травматологии и ортопедии им. Я.Л. Цивьяна» Минздрава России, Новосибирск, Россия;
2. АНО «Клиника травматологии, ортопедии и нейрохирургии НИИТО», Новосибирск, Россия
*yaringennadiy@icloud.com
________________________________________________
1. Tsivian Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia;
2. Clinic of Traumatology, Orthopedics and Neurosurgery of NRITO, Novosibirsk, Russia
*yaringennadiy@icloud.com
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