Комплексное ведение пациенток с пролапсом тазовых органов и метаболическим синдромом

Лапина И.А., Доброхотова Ю.Э., Таранов В.В., Чирвон Т.Г., Волкова П., Малахова А.А. Комплексное ведение пациенток с пролапсом тазовых органов и метаболическим синдромом. Гинекология. 2021; 23 (3): 260–266. DOI: 10.26442/20795696.2021.3. 200962

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Lapina IA, Dobrokhotova YuE, Taranov VV, Chirvon TG, Volkova P, Malakhova AA. Comprehensive management of patients with pelvis organ prolapse and metabolic syndrome. Gynecology. 2021; 23 (3): 260–266.
DOI: 10.26442/20795696.2021.3. 200962

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Аннотация

Обоснование. Генитальный пролапс (ГП) и стрессовое недержание мочи (СНМ) характеризуются несостоятельностью соединительнотканного каркаса структур тазового дна, в патогенезе которых представлено большое многообразие факторов риска. Метаболический синдром (МС), включающий ожирение и нарушение липидного, углеводного профиля, способствует инициации пролапса тазовых органов (ПТО) за счет повышения внутрибрюшного давления и наличия коморбидной патологии. Дисфункция эндотелия, характерная для МС, усугубляет имеющиеся обменные нарушения, что приводит к формированию порочного круга и повышает вероятность рецидивирования симптомов пролапса гениталий и НМ при напряжении в послеоперационном периоде.
Цель. Поиск рациональных алгоритмов комплексного ведения пациенток с ПТО и МС.
Материалы и методы. Проведен сравнительный анализ эффективности лечения пациенток с ГП и СНМ с применением хирургического метода и препаратов, воздействующих на метаболический профиль.
Результаты. Препараты, способствующие восстановлению липидного, углеводного профиля, нормализации микроциркуляторной сосудистой сети, приводят к снижению неблагоприятного воздействия компонентов МС на целостность структур тазового дна. Комплексное ведение пациенток с ПТО и МС с помощью хирургической коррекции ГП и СНМ, а также применения метаболотропных препаратов обладает высокой эффективностью и предиктивной способностью в отношении степени выраженности ПТО и риска рецидивирования клинической симптоматики в послеоперационном периоде.
Заключение. Адекватное восстановление эндотелиального слоя у пациенток с несостоятельностью мышц тазового дна и эндотелиальной дисфункцией снижает вероятность развития mesh-aссоциированных осложнений после хирургического этапа лечения.

Ключевые слова: пролапс тазовых органов, стрессовое недержание мочи, метаболический синдром, эндотелиальная дисфункция

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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.

Keywords: pelvic organ prolapse, stress urinary incontinence, metabolic syndrome, endothelial dysfunction

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Список литературы

1. Samson SL, Garber AJ. Metabolic Syndrome. Endocrinol Metab Clin North Am. 2014;43(1):1–23. DOI:10.1016/j.ecl.2013.09.009
2. Li B, Gao G, Zhang W, et al. Metabolomics analysis reveals an effect of homocysteine on arachidonic acid and linoleic acid metabolism pathway. Mol Med Rep. 2018;17(5): 6261-8. DOI:10.3892/mmr.2018.8643
3. Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020;46(1):5-14. DOI:10.1590/S1677-5538.IBJU.2018.0581
4. Naz SGM, Tehrani RF, Behroozi-Lak T, et al. Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review. Res Rep Urol. 2020;12:179-85. DOI:10.2147/RRU.S249611
5. Frigerio M, Mastrolia SA, Spelzini F, et al. Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a systematic review. Arch Gynecol Obstet. 2019;299(2):317-25. DOI:10.1007/s00404-018-5009-9
6. Lee UJ, Kerkhof MH, van Leijsen SA, Heesakkers JP. Obesity and pelvic organ prolapse. Curr Opin Urology. 2017;27(5):428-34. DOI:10.1097/mou.0000000000000428
7. Coyne KS, Wein A, Nicholson S, et al. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract. 2013;67:1015-33
8. Giri A, Hartmann KE, Hellwege JN, et al. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11–26.e13. DOI:10.1016/j.ajog.2017.01.039
9. Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and pelvic floor disorders: a review of the literature. Med Sci Monit. 2016;22:1880. DOI:10.12659/MSM.896331
10. Лапина И.А., Доброхотова Ю.Э., Таранов В.В., Чирвон Т.Г. Профилактика дисбиотических и воспалительных заболеваний влагалища и вульвы после хирургической коррекции генитального пролапса и стрессового недержания мочи. Гинекология. 2020;22(6):111-4 [Lapina IA, Dobrokhotova JE, Taranov VV, Chirvon TG. Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence. Gynecology. 2020;22(6):111-4 (in Russian)]. DOI:10.26442/20795696.2020.6.200547
11. Van Der Ploeg JM, Rengerink KO, Van Der Steen A, et al. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. Br J Obstet Gynaecol. 2015;122:1022-30.
12. Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, et al. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J. 2017;28:1685-93.
13. Seracchioli R, Raimondo D, Arena A, et al. Laparoscopic Mesh-Less Cervicosacropexy for Uterovaginal Prolapse. Female Pelvic Med Reconstr Surg. 2018;24(6):399-403. DOI:10.1097/spv.0000000000000464
14. Altman D, Väyrynen T, Engh ME, et al. Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364:1826-36.
15. Chmielewski L, Walters MD, Weber AM, Barber MD. Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol. 2011;205:69. e1-8.
16. Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and Pelvic Floor Disorders: A Review of the Literature. Med Sci Monit. 2016;22:1880-6. DOI:10.12659/MSM.896331
17. Wasserberg N, Haney M, Petrone P. Morbid obesity adversely impacts pelvic floor function in females seeking attention for weight loss surgery. Dis Colon Rectum. 2007;50(12):2096-103.
18. Otunctemur A, Dursun M, Ozbek E. Impact of metabolic syndrome on stress urinary incontinence in pre- and postmenopausal women. Int Urol Nephrol. 2014;46(8):1501-5.
19. Rogowski A, Bienkowski P, Tarwacki D. Association between metabolic syndrome and pelvic organ prolapse severity. Int Urogynecol J. 2015;26(4):563-68.
20. Kawasaki A, Corey EG, Laskey RA. Obesity as a risk for the recurrence of anterior vaginal wall prolapse after anterior colporrhaphy. J Reprod Med. 2013;58(5-6):195-9.
21. Meschia M, Rossi G, Bertini S, et al. Single incision mid-urethral slings: impact of obesity on outcomes. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):571-4. DOI:10.1016/j.ejogrb.2013.08.007
22. Moore RD, De Ridder D, Kennelly MJ. Two-year evaluation of the MiniArc in obese versus non-obese patients for treatment of stress urinary incontinence. Int J Urol. 2013;20(4):434-40.
23. Baldassarre M, Alvisi S, Berra M, et al. Changes in vaginal physiology of menopausal women with type 2 diabetes. J Sex Med. 2015;12(6):1346-55.
24. Лапина И.А., Доброхотова Ю.Э., Озолиня Л.А., и др. Комплексный подход к ведению пациенток с гиперплазией эндометрия и метаболическим синдромом. Гинекология. 2021;23(1):55-61 [Lapina IA, Dobrokhotova YuE, Ozolinya LA, et al. An integrated approach to the management of patients with endometrial hyperplasia and metabolic syndrome. Gynecology. 2021;23(1):55-61 (in Russian)].
DOI:10.26442/20795696.2021.1.200642
25. Coccheri S, Mannello F. Development and use of sulodexide in vascular diseases: implications for treatment. Drug Des Devel Ther. 2013;24:49-65.
26. Li T, Liu X, Zhao Z, et al. Sulodexide recovers endothelial function through reconstructing glycocalyx in the balloon-injury rat carotid artery model. Oncotarget. 2017;8:91350-61.
27. Mannello F, Ligi D, Raffetto JD. Glycosaminoglycan sulodexide modulates inflammatory pathways in chronic venous disease. Int Angiol. 2014;33:236-42.
28. Gava G, Alvisi S, Mancini I, et al. Prevalence of metabolic syndrome and its components in women with and without pelvic organ prolapse and its association with prolapse severity according to the Pelvic Organ Prolapse Quantification system. Int Urogynecol J. 2019;30(11):1911-7. DOI:10.1007/s00192-018-3840-y
29. Catoi AF, Pârvu AE, Andreicuț AD, et al. Metabolically healthy versus unhealthy morbidly obese: chronic inflammation, nitro-oxidative stress, and insulin resistance. Nutrients. 2018;10(9):1199. DOI:10.3390/nu10091199
30. Lucero D, López GI, Gorzalczany S, et al. Alterations in triglyceride rich lipoproteins are related to endothelial dysfunction in metabolic syndrome. Clin Biochem. 2016;49(12):932-5.
31. Collins KH, Herzog W, MacDonald GZ, et al. Obesity, metabolic syndrome, and musculoskeletal disease: common inflammatory pathways suggest a central role for loss of muscle integrity. Front Physiol. 2018;9:112. DOI:10.3389/fphys.2018.00112
32. Grygiel-Górniak B, Ziółkowska-Suchanek I, Kaczmarek E, et al. PPARgamma-2 and ADRB3 polymorphisms in connective tissue diseases and lipid disorders. Clin Interv Aging. 2018;13:463-72. DOI:10.2147/CIA.S157186
33. Isik H, Aynioglu O, Sahbaz A, et al. Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? Eur J Obstet Gynecol Reprod Biol. 2016;197:59-62. DOI:10.1016/j.ejogrb.2015.11.035

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1. Samson SL, Garber AJ. Metabolic Syndrome. Endocrinol Metab Clin North Am. 2014;43(1):1–23. DOI:10.1016/j.ecl.2013.09.009
2. Li B, Gao G, Zhang W, et al. Metabolomics analysis reveals an effect of homocysteine on arachidonic acid and linoleic acid metabolism pathway. Mol Med Rep. 2018;17(5): 6261-8. DOI:10.3892/mmr.2018.8643
3. Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020;46(1):5-14. DOI:10.1590/S1677-5538.IBJU.2018.0581
4. Naz SGM, Tehrani RF, Behroozi-Lak T, et al. Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review. Res Rep Urol. 2020;12:179-85. DOI:10.2147/RRU.S249611
5. Frigerio M, Mastrolia SA, Spelzini F, et al. Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a systematic review. Arch Gynecol Obstet. 2019;299(2):317-25. DOI:10.1007/s00404-018-5009-9
6. Lee UJ, Kerkhof MH, van Leijsen SA, Heesakkers JP. Obesity and pelvic organ prolapse. Curr Opin Urology. 2017;27(5):428-34. DOI:10.1097/mou.0000000000000428
7. Coyne KS, Wein A, Nicholson S, et al. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract. 2013;67:1015-33
8. Giri A, Hartmann KE, Hellwege JN, et al. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11–26.e13. DOI:10.1016/j.ajog.2017.01.039
9. Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and pelvic floor disorders: a review of the literature. Med Sci Monit. 2016;22:1880. DOI:10.12659/MSM.896331
10. Lapina IA, Dobrokhotova JE, Taranov VV, Chirvon TG. Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence. Gynecology. 2020;22(6):111-4 (in Russian)
DOI:10.26442/20795696.2020.6.200547
11. Van Der Ploeg JM, Rengerink KO, Van Der Steen A, et al. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. Br J Obstet Gynaecol. 2015;122:1022-30.
12. Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, et al. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J. 2017;28:1685-93.
13. Seracchioli R, Raimondo D, Arena A, et al. Laparoscopic Mesh-Less Cervicosacropexy for Uterovaginal Prolapse. Female Pelvic Med Reconstr Surg. 2018;24(6):399-403. DOI:10.1097/spv.0000000000000464
14. Altman D, Väyrynen T, Engh ME, et al. Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364:1826-36.
15. Chmielewski L, Walters MD, Weber AM, Barber MD. Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol. 2011;205:69. e1-8.
16. Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and Pelvic Floor Disorders: A Review of the Literature. Med Sci Monit. 2016;22:1880-6. DOI:10.12659/MSM.896331
17. Wasserberg N, Haney M, Petrone P. Morbid obesity adversely impacts pelvic floor function in females seeking attention for weight loss surgery. Dis Colon Rectum. 2007;50(12):2096-103.
18. Otunctemur A, Dursun M, Ozbek E. Impact of metabolic syndrome on stress urinary incontinence in pre- and postmenopausal women. Int Urol Nephrol. 2014;46(8):1501-5.
19. Rogowski A, Bienkowski P, Tarwacki D. Association between metabolic syndrome and pelvic organ prolapse severity. Int Urogynecol J. 2015;26(4):563-68.
20. Kawasaki A, Corey EG, Laskey RA. Obesity as a risk for the recurrence of anterior vaginal wall prolapse after anterior colporrhaphy. J Reprod Med. 2013;58(5-6):195-9.
21. Meschia M, Rossi G, Bertini S, et al. Single incision mid-urethral slings: impact of obesity on outcomes. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):571-4. DOI:10.1016/j.ejogrb.2013.08.007
22. Moore RD, De Ridder D, Kennelly MJ. Two-year evaluation of the MiniArc in obese versus non-obese patients for treatment of stress urinary incontinence. Int J Urol. 2013;20(4):434-40.
23. Baldassarre M, Alvisi S, Berra M, et al. Changes in vaginal physiology of menopausal women with type 2 diabetes. J Sex Med. 2015;12(6):1346-55.
24. Lapina IA, Dobrokhotova YuE, Ozolinya LA, et al. An integrated approach to the management of patients with endometrial hyperplasia and metabolic syndrome. Gynecology. 2021;23(1):55-61 (in Russian) DOI:10.26442/20795696.2021.1.200642
25. Coccheri S, Mannello F. Development and use of sulodexide in vascular diseases: implications for treatment. Drug Des Devel Ther. 2013;24:49-65.
26. Li T, Liu X, Zhao Z, et al. Sulodexide recovers endothelial function through reconstructing glycocalyx in the balloon-injury rat carotid artery model. Oncotarget. 2017;8:91350-61.
27. Mannello F, Ligi D, Raffetto JD. Glycosaminoglycan sulodexide modulates inflammatory pathways in chronic venous disease. Int Angiol. 2014;33:236-42.
28. Gava G, Alvisi S, Mancini I, et al. Prevalence of metabolic syndrome and its components in women with and without pelvic organ prolapse and its association with prolapse severity according to the Pelvic Organ Prolapse Quantification system. Int Urogynecol J. 2019;30(11):1911-7. DOI:10.1007/s00192-018-3840-y
29. Catoi AF, Pârvu AE, Andreicuț AD, et al. Metabolically healthy versus unhealthy morbidly obese: chronic inflammation, nitro-oxidative stress, and insulin resistance. Nutrients. 2018;10(9):1199. DOI:10.3390/nu10091199
30. Lucero D, López GI, Gorzalczany S, et al. Alterations in triglyceride rich lipoproteins are related to endothelial dysfunction in metabolic syndrome. Clin Biochem. 2016;49(12):932-5.
31. Collins KH, Herzog W, MacDonald GZ, et al. Obesity, metabolic syndrome, and musculoskeletal disease: common inflammatory pathways suggest a central role for loss of muscle integrity. Front Physiol. 2018;9:112. DOI:10.3389/fphys.2018.00112
32. Grygiel-Górniak B, Ziółkowska-Suchanek I, Kaczmarek E, et al. PPARgamma-2 and ADRB3 polymorphisms in connective tissue diseases and lipid disorders. Clin Interv Aging. 2018;13:463-72. DOI:10.2147/CIA.S157186
33. Isik H, Aynioglu O, Sahbaz A, et al. Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? Eur J Obstet Gynecol Reprod Biol. 2016;197:59-62. DOI:10.1016/j.ejogrb.2015.11.035

Авторы

И.А. Лапина*, Ю.Э. Доброхотова, В.В. Таранов, Т.Г. Чирвон, П. Волкова, А.А. Малахова

ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*doclapina@mail.ru

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Irina A. Lapina*, Yulia E. Dobrokhotova, Vladislav V. Taranov, Tatiana G. Chirvon, Polina Volkova, Anastasia A. Malakhova

Pirogov Russian National Research Medical University, Moscow, Russia
*doclapina@mail.ru

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