Pelvik Organ Prolapsusunda Evreleme ve Tedavi Prensipleri
Özet
Pelvik organ prolapsusu (POP), vajina ön/arka duvarı, uterus veya vajina kubbesinin aşağı doğru sarkmasıdır. Yaş, vajinal doğum, genetik faktörler, kronik öksürük ve obezite gibi intraabdominal basıncı artıran durumlar POP riskini yükseltirken, sezaryen bu riski azaltmaktadır. POP-Q sınıflaması, hymen referans noktasına göre prolapsusu evrelemek için kullanılır. Semptomsuz veya minimal semptomlu hastalarda tedavi gerekmeyebilir. Cerrahi dışı yaklaşımlarda pesser kullanımı (ring, Gelhorn) ve Kegel egzersizleri yer almaktadır. Cerrahi tedaviler ise rekonstrüktif (sakrospinöz ligament fiksasyonu, sakrokolpopeksi, uterosakral ligament süspansiyonu, anterior/posterior kolporafi) ve obliteratif (LeFort kolpoklezis) girişimler olarak ikiye ayrılır. Günümüzde yalnızca semptomatik bölgelerin onarımı hedeflenmekte ve uterus koruyucu ameliyatlar popülerlik kazanmaktadır. Ameliyat öncesi hastalar gizli stres üriner inkontinans açısından değerlendirilmelidir.
Pelvic organ prolapse (POP) is the downward descent of the anterior/posterior vaginal wall, uterus, or vaginal vault. While factors such as age, vaginal delivery, genetics, chronic coughing, and obesity that increase intraabdominal pressure elevate POP risk, cesarean delivery reduces it. The POP-Q classification is utilized to stage prolapse based on the hymen reference point. Treatment may not be required in asymptomatic or minimally symptomatic patients. Non-surgical approaches include the use of pessaries (ring, Gelhorn) and Kegel exercises. Surgical treatments are categorized into reconstructive (sacrospinous ligament fixation, sacrocolpopexy, uterosakral ligament suspension, anterior/posterior colporrhaphy) and obliterative (LeFort colpocleisis) interventions. Today, only symptomatic areas are targeted for repair, and uterine-preserving surgeries are gaining popularity. Prior to surgery, patients must be evaluated for occult stress urinary incontinence.
Referanslar
Hage-Fransen MAH, Wiezer M, Otto A, et al. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2021;100(3):373-382. doi:10.1111/aogs.14027
Blomquist JL, Muñoz A, Carroll M, et al. Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. JAMA. 2018;320(23):2438-2447. doi:10.1001/jama.2018.18315
Brito LGO, Pereira GMV, Moalli P, et al. Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis. Int Urogynecol J. 2022;33(1):15-29. doi:10.1007/s00192-021-04953-1
Vergeldt TF, Weemhoff M, IntHout J, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559-1573. doi:10.1007/s00192-015-2695-8
Raju R, Linder BJ. Evaluation and Management of Pelvic Organ Prolapse. Mayo Clin Proc. 2021;96(12):3122-3129. doi:10.1016/j.mayocp.2021.09.005
Al-Shaikh G, Syed S, Osman S, et al. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. Int J Womens Health. 2018;10:195-201. Published 2018 Apr 17. doi:10.2147/IJWH.S152616
Vasconcelos CTM, Gomes MLS, Geoffrion R, et al. Pessary evaluation for genital prolapse treatment: From acceptance to successful fitting. Neurourol Urodyn. 2020;39(8):2344-2352. doi:10.1002/nau.24493
Mooij R, Potijk TM, Schrickx JA. Complicaties van conservatieve prolapsbehandeling [Complications related to pessary use in the treatment of female pelvic organ prolapse]. Ned Tijdschr Geneeskd. 2021;165:D5706. Published 2021 Jul 22.
Harvey MA. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. J Obstet Gynaecol Can. 2003;25(6):487-498. doi:10.1016/s1701-2163(16)30310-3
Declas E, Giraudet G, De Graer C, et al. How we do an anterior sacrospinous ligament fixation for vaginal vault prolapse. Int Urogynecol J. 2021;32(12):3305-3308. doi:10.1007/s00192-021-04863-2
Li C, Hua K. The current status of sacrocolpopexy in the management of apical prolapse. Minerva Ginecol. 2020;72(3):165-170. doi:10.23736/S0026-4784.20.04477-9
Yazdany T, Bhatia N. Uterosacral ligament vaginal vault suspension: anatomy, outcome and surgical considerations. Curr Opin Obstet Gynecol. 2008;20(5):484-488. doi:10.1097/GCO.0b013e32830eb8c6
Bradley S, Gutman RE, Richter LA. Hysteropexy: an Option for the Repair of Pelvic Organ Prolapse. Curr Urol Rep. 2018;19(2):15. Published 2018 Feb 23. doi:10.1007/s11934-018-0765-4
Maher C. Anterior vaginal compartment surgery. Int Urogynecol J. 2013;24(11):1791-1802. doi:10.1007/s00192-013-2170-3
Kudish BI, Iglesia CB. Posterior wall prolapse and repair. Clin Obstet Gynecol. 2010;53(1):59-71. doi:10.1097/GRF.0b013e3181cd41e3
Bellido Luque J, Limón Padilla J, García Moreno J, et al. Three years prospective clinical and radiologic follow-up of laparoscopic sacrocolpoperineopexy. Surg Endosc. 2021;35(11):5980-5990. doi:10.1007/s00464-020-08083-5
Barber E, Kleiner I, Tairy D, et al. The effectiveness of McCall culdoplasty following vaginal hysterectomy in advanced stages of uterine prolapse. Int Urogynecol J. 2021;32(8):2143-2148. doi:10.1007/s00192-021-04890-z
