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Гибридная реконструкция тазового дна с применением влагалищного лоскута с унилатеральной апикальной фиксацией в коррекции постгистерэктомического пролапса
Гибридная реконструкция тазового дна с применением влагалищного лоскута с унилатеральной апикальной фиксацией в коррекции постгистерэктомического пролапса
Шкарупа Д.Д., Шахалиев Р.А., Кубин Н.Д., Шульгин А.С., Мульдаров З.И., Султонов Ф.П. Гибридная реконструкция тазового дна с применением влагалищного лоскута с унилатеральной апикальной фиксацией в коррекции постгистерэктомического пролапса. Гинекология. 2025;27(2):148–152. DOI: 10.26442/20795696.2025.2.203281
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Цель. Оценить анатомическую эффективность и безопасность гибридной реконструкции тазового дна с использованием влагалищного лоскута и унилатеральной апикальной фиксации у женщин с постгистерэктомическим пролапсом.
Материалы и методы. В ретроспективное исследование включены 62 пациентки с пролапсом купола культи влагалища II–IV степени (по классификации POP-Q – Pelvic Organ Prolapse Quantifications System), которым сделана хирургическая коррекция по оригинальной методике. Первичной конечной точкой считали анатомическую эффективность, вторичными – изменение качества жизни (опросники PFDI-20, ICIQ-SF) и удовлетворенность результатами лечения.
Результаты. Средняя продолжительность наблюдения – 14,86 мес. Анатомическая эффективность метода составила 93,5%, случаев эрозии импланта и хронической тазовой боли не зафиксировано. Значимое улучшение симптомов дисфункции тазового дна достигнуто по всем субшкалам опросника PFDI-20 (p<0,001). Длина влагалища статистически значимо увеличилась. В 6,5% случаев зарегистрирован рецидив пролапса, потребовавший повторной коррекции. В ходе операции отмечено 2 случая повреждения мочевого пузыря, не повлиявшие на конечный результат.
Заключение. Гибридная реконструкция тазового дна с применением влагалищного лоскута с унилатеральной апикальной фиксацией продемонстрировала высокую анатомическую эффективность и безопасность в коррекции постгистерэктомического пролапса. Тем не менее необходимы дальнейшие проспективные исследования с включением контрольных групп и более длительным периодом наблюдения.
Ключевые слова: пролапс тазовых органов, влагалищный лоскут, постгистерэктомический пролапс, коррекция постгистерэктомического пролапса
Materials and methods. This retrospective study included 62 female patients with stage II–IV vaginal vault prolapse (according to the POP-Q classification) who underwent a novel surgical technique. The primary endpoint was anatomical success; secondary endpoints included changes in quality of life (PFDI-20, ICIQ-SF questionnaires) and patient satisfaction with treatment outcomes.
Results. The mean follow-up period was 14.86 months. Anatomical success was achieved in 93.5% of cases. No cases of implant erosion or chronic pelvic pain were reported. Significant improvement in pelvic floor dysfunction symptoms was observed across all PFDI-20 subscales (p<0.001). Vaginal length significantly increased postoperatively. Recurrence of prolapse occurred in 6.5% of cases and required reoperation. Two cases of intraoperative bladder injury were noted, which did not affect the final outcomes.
Conclusion. Hybrid pelvic floor reconstruction using a vaginal flap with unilateral apical fixation demonstrated high anatomical efficacy and safety in the correction of post-hysterectomy prolapse. However, further prospective studies with control groups and longer follow-up are needed to confirm these findings.
Keywords: pelvic organ prolapse, vaginal flap, post-hysterectomy prolapse, correction of post-hysterectomy prolapse
Материалы и методы. В ретроспективное исследование включены 62 пациентки с пролапсом купола культи влагалища II–IV степени (по классификации POP-Q – Pelvic Organ Prolapse Quantifications System), которым сделана хирургическая коррекция по оригинальной методике. Первичной конечной точкой считали анатомическую эффективность, вторичными – изменение качества жизни (опросники PFDI-20, ICIQ-SF) и удовлетворенность результатами лечения.
Результаты. Средняя продолжительность наблюдения – 14,86 мес. Анатомическая эффективность метода составила 93,5%, случаев эрозии импланта и хронической тазовой боли не зафиксировано. Значимое улучшение симптомов дисфункции тазового дна достигнуто по всем субшкалам опросника PFDI-20 (p<0,001). Длина влагалища статистически значимо увеличилась. В 6,5% случаев зарегистрирован рецидив пролапса, потребовавший повторной коррекции. В ходе операции отмечено 2 случая повреждения мочевого пузыря, не повлиявшие на конечный результат.
Заключение. Гибридная реконструкция тазового дна с применением влагалищного лоскута с унилатеральной апикальной фиксацией продемонстрировала высокую анатомическую эффективность и безопасность в коррекции постгистерэктомического пролапса. Тем не менее необходимы дальнейшие проспективные исследования с включением контрольных групп и более длительным периодом наблюдения.
Ключевые слова: пролапс тазовых органов, влагалищный лоскут, постгистерэктомический пролапс, коррекция постгистерэктомического пролапса
________________________________________________
Materials and methods. This retrospective study included 62 female patients with stage II–IV vaginal vault prolapse (according to the POP-Q classification) who underwent a novel surgical technique. The primary endpoint was anatomical success; secondary endpoints included changes in quality of life (PFDI-20, ICIQ-SF questionnaires) and patient satisfaction with treatment outcomes.
Results. The mean follow-up period was 14.86 months. Anatomical success was achieved in 93.5% of cases. No cases of implant erosion or chronic pelvic pain were reported. Significant improvement in pelvic floor dysfunction symptoms was observed across all PFDI-20 subscales (p<0.001). Vaginal length significantly increased postoperatively. Recurrence of prolapse occurred in 6.5% of cases and required reoperation. Two cases of intraoperative bladder injury were noted, which did not affect the final outcomes.
Conclusion. Hybrid pelvic floor reconstruction using a vaginal flap with unilateral apical fixation demonstrated high anatomical efficacy and safety in the correction of post-hysterectomy prolapse. However, further prospective studies with control groups and longer follow-up are needed to confirm these findings.
Keywords: pelvic organ prolapse, vaginal flap, post-hysterectomy prolapse, correction of post-hysterectomy prolapse
Полный текст
Список литературы
1. Robinson D, Thiagamoorthy G, Cardozo L. Post-hysterectomy vaginal vault prolapse. Maturitas. 2018;107:39-43. DOI:10.1016/j.maturitas.2017.07.011
2. Краснопольский В.И., Буянова С.Н., Щукина Н.А., Попов А.А. Оперативная гинекология. М.: МЕДпресс-информ, 2010 [Krasnopolskii VI, Buianova SN, Shchukina NA, Popov AA. Operativnaia ginekologiia. Moscow: MEDpress-inform, 2010 (in Russian)].
3. Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt. 1):233-41. DOI:10.1097/AOG.0b013e318299a6cf
4. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36(4):897-909. DOI:10.1097/00003081-199312000-00015
5. Dällenbach P, Kaelin-Gambirasio I, Jacob S, et al. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1623-9. DOI:10.1007/s00192-008-0718-4
6. Developed by the Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Int Urogynecol J. 2020;31(3):429-63. DOI:10.1007/s00192-020-04236-1
7. Coolen AWM, Bui BN, Dietz V, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767-83. DOI:10.1007/s00192-017-3493-2
8. Zhang W, Cheon WC, Zhang L, et al. Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis. Int Urogynecol J. 2022;33(1):3-13. DOI:10.1007/s00192-017-3493-2
9. Noé GK. Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues? J Clin Med. 2021;10(2):267. DOI:10.3390/jcm10020267
10. Abhari RE, Izett-Kay ML, Morris HL, et al. Host-biomaterial interactions in mesh complications after pelvic floor reconstructive surgery. Nat Rev Urol. 2021;18(12):725-38.
11. Takacs EB, Kreder KJ. Sacrocolpopexy: surgical technique, out-comes, and complications. Curr Urol Rep. 2016;17(12):90. DOI:10.1007/s11934-016-0643-x
12. Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016-24. DOI:10.1001/jama.2013.4919
13. Tan-Kim J, Menefee SA, Luber KM, et al. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205-12. DOI:10.1007/s00192-010-1265-3
14. Сучков Д.А., Шахалиев Р.А., Шульгин А.С., и др. Унилатеральная гибридная хирургическая реконструкция тазового дна. Модифицированная лоскутная методика. Вопросы гинекологии, акушерства и перинатологии. 2024;23(1):16-23 [Suchkov DA, Shakhaliev RA, Shulgin AS, et al. Unilateral hybrid pelvic floor surgical reconstruction. Modified flap technique. Voprosy Ginekologii, Akusherstva i Perinatologii. 2024;23(1):16-23 (in Russian)]. DOI:10.20953/1726-1678-2024-1-16-23
15. Cosson M, Collinet P, Occelli B, et al. The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Eur J Obstet Gynecol Reprod Biol. 2001;95(1):73-80. DOI:10.1016/s0301-2115(00)00341-9
16. Morgan MM, Rogers DA, Huebner M, et al. Heterogenieity in anatomic outcome of a sacrospinous fixation for prolapse. A systematic review. Obstet Gyanecol. 2007;109:1424-33. DOI:10.1097/01.AOG.0000264066.89094.21
17. Nygaard IE, McCreery, Brubaker L, et al. Abdominal Sacrocolpopexy: A comprehensive review. Obstet Gynaecol. 2004;104:805-23. DOI:10.1097/01.AOG.0000139514.90897.07
18. Maher C, Yeung E, Haya N, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2023;7(7):CD012376. DOI:10.1002/14651858.CD012376.pub2
19. Qu DC, Chen HB, Yang MM, Zhou HG. Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature. Medicine (Baltimore). 2019;98(49):e18252. DOI:10.1097/MD.0000000000018252
20. Tinelli A, Yassa M, Marzo G, et al. Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier. Int J Clin Exp Pathol. 2024;17(3):90-5. DOI:10.62347/RERC7901
21. Jones KA, Zhuo Y, Solak S, Harmanli O. Hysterectomy at the time of colpocleisis: a decision analysis. Int Urogynecol J. 2016;27(5):805-10. DOI:10.1007/s00192-015-2903-6
22. Laumann EO, Paik A, Glasser DB, et al. A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors. Arch Sex Behav. 2006;35(2):145-61. DOI:10.1007/s10508-005-9005-3
23. Gencdal S, Demirel E, Soyman Z, Kelekci S. Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy. Biomed Res Int. 2019;2019:8047924. DOI:10.1155/2019/8047924
24. Chene G, Tardieu AS, Savary D, et al. Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy. Int J Urogynecol J Pelvic Floor Dysfunct. 2008;19:1007-11. DOI:10.1007/s00192-007-0549-8
25. Romanova A, Sifri Y, Gaigbe-Togbe B, et al. Trends in Apical Suspension at the Time of Hysterectomy for Pelvic Organ Prolapse: Impact of American College of Obstetricians and Gynecologists Recommendations. Female Pelvic Med Reconstr Surg. 2022;28(3):e66-72. DOI:10.1097/SPV.0000000000001143
2. Krasnopolskii VI, Buianova SN, Shchukina NA, Popov AA. Operativnaia ginekologiia. Moscow: MEDpress-inform, 2010 (in Russian).
3. Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt. 1):233-41. DOI:10.1097/AOG.0b013e318299a6cf
4. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36(4):897-909. DOI:10.1097/00003081-199312000-00015
5. Dällenbach P, Kaelin-Gambirasio I, Jacob S, et al. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1623-9. DOI:10.1007/s00192-008-0718-4
6. Developed by the Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Int Urogynecol J. 2020;31(3):429-63. DOI:10.1007/s00192-020-04236-1
7. Coolen AWM, Bui BN, Dietz V, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767-83. DOI:10.1007/s00192-017-3493-2
8. Zhang W, Cheon WC, Zhang L, et al. Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis. Int Urogynecol J. 2022;33(1):3-13. DOI:10.1007/s00192-017-3493-2
9. Noé GK. Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues? J Clin Med. 2021;10(2):267. DOI:10.3390/jcm10020267
10. Abhari RE, Izett-Kay ML, Morris HL, et al. Host-biomaterial interactions in mesh complications after pelvic floor reconstructive surgery. Nat Rev Urol. 2021;18(12):725-38.
11. Takacs EB, Kreder KJ. Sacrocolpopexy: surgical technique, out-comes, and complications. Curr Urol Rep. 2016;17(12):90. DOI:10.1007/s11934-016-0643-x
12. Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016-24. DOI:10.1001/jama.2013.4919
13. Tan-Kim J, Menefee SA, Luber KM, et al. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205-12. DOI:10.1007/s00192-010-1265-3
14. Suchkov DA, Shakhaliev RA, Shulgin AS, et al. Unilateral hybrid pelvic floor surgical reconstruction. Modified flap technique. Voprosy Ginekologii, Akusherstva i Perinatologii. 2024;23(1):16-23 (in Russian). DOI:10.20953/1726-1678-2024-1-16-23
15. Cosson M, Collinet P, Occelli B, et al. The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Eur J Obstet Gynecol Reprod Biol. 2001;95(1):73-80. DOI:10.1016/s0301-2115(00)00341-9
16. Morgan MM, Rogers DA, Huebner M, et al. Heterogenieity in anatomic outcome of a sacrospinous fixation for prolapse. A systematic review. Obstet Gyanecol. 2007;109:1424-33. DOI:10.1097/01.AOG.0000264066.89094.21
17. Nygaard IE, McCreery, Brubaker L, et al. Abdominal Sacrocolpopexy: A comprehensive review. Obstet Gynaecol. 2004;104:805-23. DOI:10.1097/01.AOG.0000139514.90897.07
18. Maher C, Yeung E, Haya N, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2023;7(7):CD012376. DOI:10.1002/14651858.CD012376.pub2
19. Qu DC, Chen HB, Yang MM, Zhou HG. Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature. Medicine (Baltimore). 2019;98(49):e18252. DOI:10.1097/MD.0000000000018252
20. Tinelli A, Yassa M, Marzo G, et al. Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier. Int J Clin Exp Pathol. 2024;17(3):90-5. DOI:10.62347/RERC7901
21. Jones KA, Zhuo Y, Solak S, Harmanli O. Hysterectomy at the time of colpocleisis: a decision analysis. Int Urogynecol J. 2016;27(5):805-10. DOI:10.1007/s00192-015-2903-6
22. Laumann EO, Paik A, Glasser DB, et al. A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors. Arch Sex Behav. 2006;35(2):145-61. DOI:10.1007/s10508-005-9005-3
23. Gencdal S, Demirel E, Soyman Z, Kelekci S. Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy. Biomed Res Int. 2019;2019:8047924. DOI:10.1155/2019/8047924
24. Chene G, Tardieu AS, Savary D, et al. Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy. Int J Urogynecol J Pelvic Floor Dysfunct. 2008;19:1007-11. DOI:10.1007/s00192-007-0549-8
25. Romanova A, Sifri Y, Gaigbe-Togbe B, et al. Trends in Apical Suspension at the Time of Hysterectomy for Pelvic Organ Prolapse: Impact of American College of Obstetricians and Gynecologists Recommendations. Female Pelvic Med Reconstr Surg. 2022;28(3):e66-72. DOI:10.1097/SPV.0000000000001143
2. Краснопольский В.И., Буянова С.Н., Щукина Н.А., Попов А.А. Оперативная гинекология. М.: МЕДпресс-информ, 2010 [Krasnopolskii VI, Buianova SN, Shchukina NA, Popov AA. Operativnaia ginekologiia. Moscow: MEDpress-inform, 2010 (in Russian)].
3. Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt. 1):233-41. DOI:10.1097/AOG.0b013e318299a6cf
4. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36(4):897-909. DOI:10.1097/00003081-199312000-00015
5. Dällenbach P, Kaelin-Gambirasio I, Jacob S, et al. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1623-9. DOI:10.1007/s00192-008-0718-4
6. Developed by the Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Int Urogynecol J. 2020;31(3):429-63. DOI:10.1007/s00192-020-04236-1
7. Coolen AWM, Bui BN, Dietz V, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767-83. DOI:10.1007/s00192-017-3493-2
8. Zhang W, Cheon WC, Zhang L, et al. Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis. Int Urogynecol J. 2022;33(1):3-13. DOI:10.1007/s00192-017-3493-2
9. Noé GK. Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues? J Clin Med. 2021;10(2):267. DOI:10.3390/jcm10020267
10. Abhari RE, Izett-Kay ML, Morris HL, et al. Host-biomaterial interactions in mesh complications after pelvic floor reconstructive surgery. Nat Rev Urol. 2021;18(12):725-38.
11. Takacs EB, Kreder KJ. Sacrocolpopexy: surgical technique, out-comes, and complications. Curr Urol Rep. 2016;17(12):90. DOI:10.1007/s11934-016-0643-x
12. Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016-24. DOI:10.1001/jama.2013.4919
13. Tan-Kim J, Menefee SA, Luber KM, et al. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205-12. DOI:10.1007/s00192-010-1265-3
14. Сучков Д.А., Шахалиев Р.А., Шульгин А.С., и др. Унилатеральная гибридная хирургическая реконструкция тазового дна. Модифицированная лоскутная методика. Вопросы гинекологии, акушерства и перинатологии. 2024;23(1):16-23 [Suchkov DA, Shakhaliev RA, Shulgin AS, et al. Unilateral hybrid pelvic floor surgical reconstruction. Modified flap technique. Voprosy Ginekologii, Akusherstva i Perinatologii. 2024;23(1):16-23 (in Russian)]. DOI:10.20953/1726-1678-2024-1-16-23
15. Cosson M, Collinet P, Occelli B, et al. The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Eur J Obstet Gynecol Reprod Biol. 2001;95(1):73-80. DOI:10.1016/s0301-2115(00)00341-9
16. Morgan MM, Rogers DA, Huebner M, et al. Heterogenieity in anatomic outcome of a sacrospinous fixation for prolapse. A systematic review. Obstet Gyanecol. 2007;109:1424-33. DOI:10.1097/01.AOG.0000264066.89094.21
17. Nygaard IE, McCreery, Brubaker L, et al. Abdominal Sacrocolpopexy: A comprehensive review. Obstet Gynaecol. 2004;104:805-23. DOI:10.1097/01.AOG.0000139514.90897.07
18. Maher C, Yeung E, Haya N, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2023;7(7):CD012376. DOI:10.1002/14651858.CD012376.pub2
19. Qu DC, Chen HB, Yang MM, Zhou HG. Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature. Medicine (Baltimore). 2019;98(49):e18252. DOI:10.1097/MD.0000000000018252
20. Tinelli A, Yassa M, Marzo G, et al. Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier. Int J Clin Exp Pathol. 2024;17(3):90-5. DOI:10.62347/RERC7901
21. Jones KA, Zhuo Y, Solak S, Harmanli O. Hysterectomy at the time of colpocleisis: a decision analysis. Int Urogynecol J. 2016;27(5):805-10. DOI:10.1007/s00192-015-2903-6
22. Laumann EO, Paik A, Glasser DB, et al. A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors. Arch Sex Behav. 2006;35(2):145-61. DOI:10.1007/s10508-005-9005-3
23. Gencdal S, Demirel E, Soyman Z, Kelekci S. Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy. Biomed Res Int. 2019;2019:8047924. DOI:10.1155/2019/8047924
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23. Gencdal S, Demirel E, Soyman Z, Kelekci S. Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy. Biomed Res Int. 2019;2019:8047924. DOI:10.1155/2019/8047924
24. Chene G, Tardieu AS, Savary D, et al. Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy. Int J Urogynecol J Pelvic Floor Dysfunct. 2008;19:1007-11. DOI:10.1007/s00192-007-0549-8
25. Romanova A, Sifri Y, Gaigbe-Togbe B, et al. Trends in Apical Suspension at the Time of Hysterectomy for Pelvic Organ Prolapse: Impact of American College of Obstetricians and Gynecologists Recommendations. Female Pelvic Med Reconstr Surg. 2022;28(3):e66-72. DOI:10.1097/SPV.0000000000001143
Авторы
Д.Д. Шкарупа, Р.А. Шахалиев*, Н.Д. Кубин, А.С. Шульгин, З.И. Мульдаров, Ф.П. Султонов
ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия
*rustam.shahaliev@gmail.com
Saint Petersburg State University, Saint Petersburg, Russia
*rustam.shahaliev@gmail.com
ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия
*rustam.shahaliev@gmail.com
________________________________________________
Saint Petersburg State University, Saint Petersburg, Russia
*rustam.shahaliev@gmail.com
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