Surgical correction of anterior apical genital prolapse from the position of surgical access

Pelvic floor dysfunction remains a stumbling block in the surgical practice of gynecology, and the number of patients with genital prolapse is still increasing. Available studies describe a pathogenetic relationship between cystocele formation and genital prolapse, which occurs in 20% of patients with pelvic organ prolapse. The use of synthetic materials has opened up many possibilities for its surgical correction. However, the first long-term results made it necessary to stop the use of synthetic materials in some countries and search for compromise solutions to minimize iatrogenic complications. Objective. To compare the long-term results of vaginal colpopexy with the mesh implant and minimally invasive abdominal sacrocolpopexy in patients with the anterior apical genital prolapse. Material and methods. A comparative non-randomized retro- and prospective multicenter study comprised 192 patients with anterior apical genital prolapse of the III-IV stages who underwent surgical intervention in the period from 2013 to 2021 in three clinics: the Moscow Obstetrics and Gynecology Research Institute, the Sechenov University Urology Clinic, and the Moskvorechye Clinic. Vaginal colpopexy by the mesh implant «Opur» was performed in the 1st group (n=112), and laparoscopic sacrocolpopexy was performed in the 2nd group (n=80). Results. The median follow-up was 48.2 [34.3; 64.0] and 50.0 [31.7; 78.5] months in the 1st and 2nd groups, respectively. There were 7 (6.3%) cases of recurrence in the vaginal colpopexy group and 13 (16.3%) after sacrocolpopexy. According to the results of the questionnaire, Group 1 had the best score according to the PFDI-20 and PISQ-7 indices (96.4 and 91.1% of the patients respectively), Group 2 showed a higher rate of clinical improvement according to the PISQ-12 (94.7%). The patients who underwent vaginal correction of genital prolapse had 4 (3.6%) cases of mesh prosthesis extrusion (3 vaginal erosions and 1 bladder-lumen extrusion) but none after promontofixation. Conclusion. The choice of access for anterior apical prolapse correction is influenced by the following factors: somatic pathology, surgical history, type of Galban’s fascia defect, relation of cystocele and hysteroptosis between them, age and presence of sexual intercourse.