Pelvik Organ Prolapsusu (POP)
Özet
Pelvik organ prolapsusu (POP); kas, ligaman ve fasyanın zayıflamasıyla pelvik organların sarkması sonucu gelişen, kadınlarda yaygın bir ürojinekolojik sorundur. Yaşlanma, ırk, menopoz, vajinal doğum, obezite, konstipasyon ve sigara gibi modifiye edilebilen veya edilemeyen birçok risk faktörü etyolojide rol oynar. POP-Q sistemiyle evrelendirilen bu durum; pelvik dolgunluk, idrar ve dışkılama disfonksiyonu ile cinsel rahatsızlıklara yol açarak yaşam kalitesini olumsuz etkiler. Tedavide hafif vakalarda gözlem, kilo kontrolü ve lifli diyet gibi yaşam tarzı değişiklikleri önerilir. Konservatif yöntemler arasında pelvik taban kas egzersizleri (PTKE/Kegel), elektrik ve vibrasyon stimülasyonları ile mekanik destek sağlayan pesser kullanımı yer alır. İleri derece veya semptomatik olgularda ise hastanın fertilite beklentisine ve cinsel hayatına göre cerrahi tedavi planlanır. Cerrahi seçenekler arasında fertilite arzusu olmayanlarda vajinal histerektomi, vajinal kafın kısaltıldığı kolpoklezis ve apikal destek sağlayan sakrospinöz fiksasyon, iliokoksigeus, uterosakral veya abdominal sakrokolpopeksi gibi süspansiyon prosedürleri bulunur. Her cerrahi işlemin enfeksiyon, kanama ve vajinal kısalma gibi komplikasyon riskleri mevcut olup öncelikle invaziv olmayan yöntemler denenmelidir.
Pelvic organ prolapse (POP) is a common urogynecological problem in women that develops as a result of the prolapse of pelvic organs due to the weakening of muscles, ligaments, and fascia. Many modifiable or non-modifiable risk factors, such as aging, race, menopause, vaginal delivery, obesity, constipation, and smoking, play a role in its etiology. This condition, staged with the POP-Q system, negatively affects the quality of life by causing pelvic fullness, urinary and defecation dysfunction, and sexual discomfort. In treatment, observation and lifestyle changes such as weight control and a high-fiber diet are recommended for mild cases. Conservative methods include pelvic floor muscle training (PFMT/Kegel), electrical and vibratory stimulations, and the use of pessaries providing mechanical support. In advanced or symptomatic cases, surgical treatment is planned according to the patient's fertility expectations and sexual life. Surgical options include vaginal hysterectomy for those without fertility desire, colpocleisis where the vaginal cuff is shortened, and suspension procedures providing apical support such as sacrospinous fixation, iliococcygeus, uterosacral, or abdominal sacrocolpopexy. Every surgical procedure carries risks of complications such as infection, bleeding, and vaginal shortening, and non-invasive methods should be tried first.
Referanslar
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