Since pelvic organ prolapse is a common pathology in women, and an increase in life expectancy leads to an increase in the frequency of this pathology, [1, 2] it is relevant to analyze genital prolapse in combination with other somatic diseases.

Analysis of somatic diseases in women operated on for genital prolapse.

A total of 601 patients with post-hysterectomy prolapse were evaluated with POP-Q grade I-IV grade. 62 patients were evaluated for bone mineral density using dual energy X-ray absorptiometry DXA (Dual Energy X-ray Absorptiometry), with the determination of the T-criterion according to WHO criteria [3]. Processing of the data was carried out using software. Statistical analysis was performed using the tau-Kendall rank correlation coefficient.
Patients with a history of hypertension were: I degree -%, II degree - 26.2%, III degree - 42.3%; varicose veins of the lower extremities - 6.3%; diabetes mellitus - 5.4% (since type I and II diabetes mellitus did not require additional research methods in the preoperative and postoperative period, this pathology was not considered separately).
An inverse correlation was proved between the presence of grade II POP-Q prolapse and diagnosed anemia (Z = -5.04; p <0.0001). A direct correlation was found between the diagnosed post hysterectomy genital prolapse and hypertension (Z = 2.97; p = 0.003) and the absence of a relationship with diabetes mellitus and varicose veins of the lower extremities. There was no correlation between POP-Q grade II prolapse with diabetes mellitus, hypertension, varicose veins of the lower extremities. In 62 patients with pelvic prolapse, a violation of bone mineral density from the spine was diagnosed with a T-criterion of -1.3, in contrast to the T-criterion of the right femur -0.44 and the T-criterion of the left femur -0.44, which also characteristic of postmenopausal women. An analysis was made of the relationship between the degree of pelvic organ prolapse according to the POP-Q classification and the results of assessing the mineral density of the vertebrae, right and left femurs (T-test). A direct correlation was found between the degree of prolapse according to POP-Q III degree and the bone mineral density (2.12; p-value <0.04). Thus, genital prolapse according to POP-Q III degree can be evaluated as a marker that allows predicting osteopenic syndrome.
Taking into account extragenital pathology and the volume of surgery, the following types of anesthesia were selected: total iv anesthesia + mechanical ventilation (8.6%), spinal anesthesia (86.8%) and intravenous anesthesia (6.1%).
The age of the operated patients was predominantly older than 49 years (80.1%), the average duration of the disease was 6.1 years, and the average duration of postmenopause was 10.6 years. According to these data, genital prolapse presumably progresses in the postmenopausal period.
Patients underwent the following operations:
- during post hysterectomy prolapse, colpopexy was performed (“simplified” promofixation (52 patients), sacrospinal fixation (27 patients), the use of mesh endoprosthesis for reconstruction of the anterior and apical parts of the pelvic floor (103 patients)), the median colporaphia of the Lefora – Neugebueuber joint transobturator access (13 patients);
A “simplified” promontofixation is a fixation of the distal mesh prosthesis to the dome of the vagina, proximal to the promontrium. If the preoperative diagnosis is satisfactory and violations of bone mineral density are excluded, the proximal section of the mesh prosthesis is fixed with an anchor. This technique allows not to conduct a deep dissection of tissues to the puborectal muscle and bladder and to exclude possible complications in the postoperative period. A condition for sacrospinal fixation was a vaginal length of at least 9 cm. For symptomatic cystocele and a vaginal length of more than 9 cm, as well as in the absence of conditions for a “simplified” fixation, a mesh endoprosthesis was used to reconstruct the anterior and apical pelvic floor.
- in the presence of the cervix, a unilateral sacro-spinous fixation was performed using a mesh prosthesis (38 patients);
- in all other cases, TVT was installed with vaginal plastic surgery (377 patients), without vaginal plastic surgery (21 patients);
- 419 patients additionally underwent pelvic floor muscle reconstruction.

A direct correlation was revealed between genital prolapse according to POP-Q III degree and the presence of hypertension (Z = 2.59; p <0.01), anemia (Z = 3.53; p <0.0001), diabetes mellitus (Z = 2.21; p = 0.03), while the combination of hypertension and diabetes can increase the risks of genital prolapse. An advantageous correction method is a “simplified” fixation with fixation with an anchor with preliminary diagnostics of bone mineral density. For non-correctable arterial hypertension, vaginal access is preferable, due to the high risk of complications with laparotomy and laparoscopy, taking into account the length of the vagina.

To date, the combination of arterial hypertension, diabetes mellitus, decreased bone mineral density and pelvic prolapse in older women is an urgent problem, due to the high prevalence of somatic pathology data in postmenopausal women and a decrease in the quality of life in these patients.

Cao Q, Chen YS, Ding JX, et al. Long-term treatment outcomes of transvaginal mesh surgery versus anterior-posterior colporrhaphy for pelvic organ prolapse. Aust N Z J Obstet Gynaecol 2013;53:79-85.
Yashchuk AG., Musin II., Naftulovich RA., Popova EM. et al. Evaluation of implant-associated complications when installing mesh prostheses in the reconstruction of the pelvic floor // Gynecology. - 2019. - T. 21. No. 5. P: 69-73 (in Russ.).
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