Modified technique of vaginal hysterectomy, placing polypropylene mesh TOT Sling and IVS methods in solving the associated static disorders of female genital organs and stress incontinentio urinae

摘要

Introduction: static disorders of female genital organs, present a problem and a professional challenge for any gynecologist who deals with the operational uroginecology. Frequent relapses of these disorders, after using the classical surgical techniques, have led to new research, technological progress in the production of polypropylene grafts and development of modern operational approaches to these problems. Newer surgical techniques haveled to the construction of retaining polypropylene mesh, in terms of solving the disorders. Stress incontinentio urinae (SUI) and strengthening of the pelvic bottom, as well as prevention of a relapse Rectocoella and Enterocoella.The aim of the study was to present a modification of the classical techniques of vaginal hysterectomy, taking into consideration the recommendations of the authority in the field of vaginal surgery. Also, it indicates the great importance of introducing operational techniques of application polypropylene mesh grafts in correction in the following SUI and strengthening of the pelvic bottom… Case: we present a case of sexagenarian patient with total prolapse of the uterus, followed by the SUI of the middle level, and with evident Rectocoellomi Enterocoella. At council has decided to do a modified technique of total vaginal hysterectomy (TVH), and after that, we did a setting of semi rigid polypropylene mesh by transobtural (TOT Sling) method, in order to obtain SUI correction, and setting of intravaginal slings (IVS) by polypropylene mesh, in order to make a correction of Rectocoellae and Enterocoellae. The surgery has been done in spinal anesthesia. Operative and postoperative flows occurred regularly. The catheter was removed the third postoperative day. The patient urinates spontaneously without residue, controls the micturition. Fifth postoperative day the patient passed faeces, proper and controlled, and was dismissed to home care, for recovered. Discussion and conclusion: problems of our female patient were solved using the described technique and interdisciplinary approach.We removed the prolapsed uterus, solved the problem of SUI and strengthened the pelvic bottom. Interdisciplinary solving of the static disorder of female genital organs is necessary, in order to achieve optimal solving of these problems. The controls after a month, after three and six months, showed that our patient has no subjective discomfort, micturitionis orderly, controlled and there is no sign of Cistocoellae and Enterocoellae. Ultrasound finding is neat, after micturition there is no resudue. The patient lives a normal life and has returned to normal life activities. We think that these techniques are, currently, in our conditions, the ideal approach to solve these problems