Development of a strategy for choosing a method of surgical treatment of stress urinary incontinence combined with cystocele in postmenopausal women based on a comprehensive preoperative examination.

A prospective randomized study was conducted, which included 80 postmenopausal women with stress urinary incontinence (SUI) combined with cystocele. All patients, after signing voluntary informed consent to participate in the study, were randomized into two groups using a random number generator. The first group (group A) consisted of 40 women who underwent sling surgery combination with anterior vaginal repair native tissue; the second group of women (group B) included 40 patients who underwent paraurethral injection of a bulking gel in combination with anterior vaginal repair native tissue. Before surgical treatment, all patients underwent a general clinical standard examination, supplemented by a ambulatory urodynamics study and ultrasound imaging . All patients had their blood taken for molecular genetic testing. Typing of polymorphism of genes encoding proteins involved in the formation of connective tissue - COL1A1:-1997 C>A, COL1A1:1546 G>T, genes of estrogen receptors - ESR1:-397 T>C, ESR1:-351 A>G was carried out. Statistical data processing was carried out using the application software package, "Excel", "SPP Statistics 22.0", Statistica for Windows 10.

The development of a personalized approach to predicting the outcome of surgical treatment was continued using discriminant analysis methods, which allow finding a set of indicators that most reliably separate satisfied and dissatisfied patients for each type of surgery. Based on discriminant analysis, the most informative criteria for the effectiveness of sling surgery combination with anterior vaginal repair native tissue. A prediction rule was constructed based on the calculation of the prognostic index X, which has the following form:
X= -7.9285*x1 + 0.2587*x2 + 0.4650*x3 – 3.8844
X– prognostic index of the effectiveness of the method used
x1– difference in the width of the urethra at rest and during straining according to ultrasound imaging(cm)
x2– average urine flow rate according to uroflowmetry (ml/sec)
x3– carriage of the GG genotype of the ESR:-351 gene (0-no; 1-yes).
At X>0, the model predicts a negative outcome of sling surgery combination with anterior vaginal repair native tissue.
At X<0, the model predicts a positive outcome of sling surgery combination with anterior vaginal repair native tissue.
Similarly, the most informative criteria of effectiveness were determined for the method of paraurethral injection of a volume-forming gel in combination with anterior vaginal repair native tissue.
As a result, a rule was constructed based on the calculation of the prognostic index Z, which has the following form:
Z= 1.390* x1 - 0.3216* x2 – 0.7385* x3 + 6.184Z – prognostic index of the effectiveness of the method used
x1– urethral length according to ultrasound examination of the pelvic floor and lower urinary tract (cm)
x2– maximum urine flow rate according to uroflowmetry (ml/sec)
x3– carriage of the GG genotype of the COL1A1:1546 gene (0-no; 1-yes)
If Z>0, the model predicts a negative outcome of surgical treatment by paraurethral injection of a bulking gel in combination with canterior vaginal repair native tissue .
If Z<0, the model predicts a positive outcome of surgical treatment by paraurethral injection of a bulking gel in combination anterior vaginal repair native tissue

The developed method allows to optimize the tactics of management of patients with SUI in combination with cystocele in the postmenopausal period, thereby increasing the effectiveness of surgical interventions.

The developed prognostic formulas allow the clinician to choose a method of effective surgical treatment of SUI in combination with cystocele in postmenopausal women, thereby implementing a personalized approach.