Volume 04 Issue 11-2024
23
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
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P
AGES
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23-30
OCLC
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1121105677
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ABSTRACT
Pelvic organ prolapse (POP) is one of the most common gynecological pathologies in middle-aged and elderly women.
POP is detected in 15-30% of women, reaching 40% in the age group over 50 years (1, 2).
Pelvic organ prolapse and stress urinary incontinence are among the most common diseases in women of middle and
older age groups. Currently, this pathology accounts for at least 30% of the structure of gynecological diseases. Studies
of morbidity over the past few years show that about 14% of women require surgical correction of pelvic organ
prolapse [3]. According to a large-scale study in the population by Wu JM et al., 20% of women by the age of 80
undergo surgery for genital prolapse, with the peak of surgical activity occurring at the age of 71-73 years (4.3 per 1000
women) [4].
Research Article
ANALYSIS AND ASSESSMENT OF THE QUALITY OF LIFE OF WOMEN
WITH PROLAPSE OF PELVIC ORGANS
Submission Date:
November 15, 2024,
Accepted Date:
November 20, 2024,
Published Date:
November 25, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue11-04
Usmanova Barno
Department of Obstetrics and Gynecology in Family Medicine, Tashkent Medical Academy, Tashkent,
Uzbekistan
Yuldasheva Dilchehra
Department of Obstetrics and Gynecology in Family Medicine, Tashkent Medical Academy, Tashkent,
Uzbekistan
Chorieva Gulchekhra
Department of Obstetrics and Gynecology in Family Medicine, Tashkent Medical Academy, Tashkent,
Uzbekistan
Irnazarova Dinara
Department of Obstetrics and Gynecology in Family Medicine, Tashkent Medical Academy, Tashkent,
Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 11-2024
24
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
04
ISSUE
11
P
AGES
:
23-30
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
KEYWORDS
Analysis, Quality of Life of Women, Increasing life expectancy.
INTRODUCTION
Pelvic organ prolapse (POP) is one of the most
common gynecological pathologies in middle-aged and
elderly women. POP is detected in 15-30% of women,
reaching 40% in the age group over 50 years (1, 2).
Pelvic organ prolapse and stress urinary incontinence
are among the most common diseases in women of
middle and older age groups. Currently, this pathology
accounts for at least 30% of the structure of
gynecological diseases. Studies of morbidity over the
past few years show that about 14% of women require
surgical correction of pelvic organ prolapse [3].
According to a large-scale study in the population by
Wu JM et al., 20% of women by the age of 80 undergo
surgery for genital prolapse, with the peak of surgical
activity occurring at the age of 71-73 years (4.3 per 1000
women) [4].
Increasing life expectancy and prevalence of obesity in
the population are predictors of further growth of the
disease. Cystocele caused by defect of pubocervical
fascia is the most common form of prolapse, occurring
in one third of women aged 50
–
79 years regardless of
uterine status [5]. The traditional method of cystocele
correction is colporrhaphy, which consists of applying
absorbable sutures to the anterior vaginal wall, was
first described by Kelly in 1913 [6]. Clinical experience
accumulated over decades has shown that the reason
for high recurrence rate (20
–
92%) of prolapse is failure
of th
e patient’s own tissues used for plastic surgery,
which dictates the need to search for more reliable
methods of correction [7,8]. The solution to the
problem appeared with the introduction of synthetic
materials into surgical practice.
The aim
of our study is to optimize the technique of
surgical treatment of urinary incontinence in pelvic
organ prolapse.
METHODS
The study was conducted in 2020-2023 at the City
Maternity Hospital No. 8 and the private medical clinic
CityMed. All women were asked to complete the PFDI-
20 electronic questionnaire as part of a clinical trial. A
promising cross-sectional study was conducted as part
of the analytical approach.
The exact number of women with urinary incontinence
in Uzbekistan is unknown. The lack of this information
prompted us to conduct a study in our country to
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determine the prevalence, types and characteristics of
urinary incontinence in women, and to analyze risk
factors. Although many studies have presented data
from different parts of the world, we believe that this
study was the first to address the user interface issue
in Uzbekistan. Differences in culture, dietary habits,
climate and social attitudes may cause women in
Uzbekistan to have different outcomes compared to
other women in different parts of the world.
The questionnaire was created and distributed using
the domain https://prolaps-survey.uz/, http://urino-
survey.uz, https://surgery-survey.uz this was a secure
web platform for creating and managing surveys and
online databases, which was distributed to
respondents through Telegram channels. The
questionnaires were filled in by women independently
after signing informed voluntary consent. This domain
https://prolaps-survey.uz/ was used to analyze the
PFID-20 survey and use this survey to study the
prevalence of the problem among Uzbek women. The
domain http://urino-survey.uz was used by women
who sought surgical treatment with complaints of
problems with the pelvic organs. This domain
https://surgery-survey.uz was used to assess the
condition of women for 10 years after surgery.
The electronic survey involved 517 women aged 20 to
50 years (mean age 34.8±1.3 years). Women answered
the PFID-20 survey anonymously from their mobile
devices. The results were summarized and calculated
in accordance with the arithmetic mean key of the
questionnaire. The reliability of the method was 0.86,
R<0.001, sensitivity was 1.48, R<0.0001, standardized
response was 1.09, R<0.0001.
The collection of statistical materials was processed
using the Jamovi 2.2.5.0 program. The correlation
coefficient, assessing the nature of the relationship
between the studied indicators, was calculated using
the Spearman level correlation method, and the
strength of the relationship was assessed using the
Chadock scale.
All women were asked to anonymously complete the
electronic PFDI-20 questionnaire as part of a clinical
trial. A promising cross-sectional study was used in the
analytical approach.
An electronic survey was conducted among 349
women (mean age 36.8±1.3 years) aged 20 to 50 years.
Women answered the PFID-20 survey from their
mobile devices. The results were summarized and
calculated in accordance with the arithmetic mean key
of the questionnaire. The reliability of the method was
0.86, R<0.001, sensitivity was 1.48, R<0.0001,
standardized response was 1.09, R<0.0001.
In accordance with the objectives of the study, we
divided all 349 women into 3 groups:
The main group consisted of 274 women, divided into:
Group 1 - women with genital prolapse who underwent
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transurethral placement of a medial urethral loop
(TVT), n=133, Group 2 - women who underwent Kelly
surgery modified with U-shaped suture for stress
urinary incontinence, n=141, Group 3 (control)
–
conditionally healthy women of reproductive age,
n=75.
Data were collected from women and their
accompanying persons and selected randomly. All
women over 18 years of age who agreed to participate
in the study were included in the study. This study was
conducted in two stages. In the first stage, to
determine the frequency of urinary incontinence and
study the risk factors affecting it, women who applied
for surgical treatment were examined and interviewed
using an electronic questionnaire.
RESULTS
The exclusion criteria at both stages were pregnancy
or childbirth within the last 3 months, gynecological
surgery or lower urinary tract surgery within the
previous 3 months, and patient refusal to participate in
the study. After studying the age characteristics of the
applicants, it was found that in Group 1, people aged
36-40 years predominated (42.1%), in Group 2, people
aged 41-45 years predominated (34%), and in the
control group, people aged 26-30 years predominated
(36%). The average age of the subjects in the first and
second groups was 37.2±0.28 and 37.8±0.33 years,
respectively. However, in the control group, the
average age was 35.4±0.45 years. The overwhelming
majority of women in the main groups were 31-45 years
old, which confirms the opinion that the development
of genital prolapse depends on age (fig. 1).
Fig. 1. Age composition of the examined patients, (%)
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Analysis of the characteristics of the div weight of
the examined women showed that in the first and
second groups of women with normal div weight
there were 55 and 48 (41.4% and 34%), overweight - 45
and 48 (33.8% and 34%), obesity - 29 and 42 (21.8% and
29.8%), and underweight was observed in 4 women
and 3 in 3 (3% and 2.1%, respectively) (fig. 2).
Figure 2. Body mass index of the studied patients, (%)
The results of the data obtained show the effect of
overweight and obesity on increased abdominal
pressure as one of the risk factors contributing to the
development of genital prolapse.
Obstetric history, including pregnancy, vaginal delivery
and the total number of surgeries, did not reveal
statistically significant differences between women. As
one of the obstetric risk factors, perineal ruptures are
often observed during vaginal delivery. In both groups,
the number of vaginal deliveries did not differ
significantly and amounted to almost the same
percentages (88.7 and 84.3%). It was found that in
groups 1 and 2 this indicator was, on average, 1.4 times
higher than in the control group, which consisted of 1-
5 deliveries (fig. 3).
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Figure 3. Comparative results by obstetric history, %
The number of more than five deliveries in women in
group 2 was 4.5 times more than in the control group
and 5.6 times more than in group 1. In both groups,
there was a significant number of perineo- and
episiotomies and ligations during vaginal delivery (76.7
and 82.9%), which are considered to be the main causes
of pelvic floor muscle insufficiency.
It is known that negative factors can disrupt the
functioning of organs and systems, cause a complex of
metabolic disorders, contribute to pelvic floor muscle
insufficiency (PFMI) and PG in combination with
diabetes mellitus, obesity, cardiovascular diseases (9,
10, 11, 12).
The ICIQ-SF scale was used to assess the impact of
urinary incontinence on quality of life. Our study
showed that women who cannot control urine flow
feel ashamed and guilty, so they often do not seek
medical attention. Women's social roles, such as work,
driving, and shopping, are complicated, and it is
emphasized that this problem affects quality of life
(13).
Table 1
Statistics based on the ICIQ-SF survey results, (%)
I group (n=133)
II group (n=141)
the absolute
number
%
the absolute
number
%
1-5 (easy)
100
75.2
54
38.3
5.3
76.7
18
6.8
88.7
4.5
84.2
14.3
1.5
76.7
2.1
80.1
17.7
2.1
84.3
13.5
80.1
18.4
1.4
82.9
2.7
81.3
16
10.7
77.3
12
89.3
6.7
4
41.3
0
10
20
30
40
50
60
70
80
90
100
1-group (n=133)
2-group (n=141)
3-group (n=75)
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6-12 (average)
25
18.0
55
39.0
13-18 (heavy)
4
2.9
20
14.2
19-21 (extremely heavy)
4
3.0
4
2.8
More than half (60%) of women who cannot urinate
have low self-esteem. In our study, the average
frequency of urinary incontinence in the second group
was 55 (39%) cases, which was twice as often as in the
first group, and in the second group, the frequency of
severe urinary incontinence was four times higher than
in the first group - 20 (14.2%). These indicators
negatively affected their quality of life, which was
assessed by ICIQ-SF scale. It was found that the highest
incidence of ICIQ-SF was the same (3 and 2.8%) in both
groups associated with urinary incontinence problems
(table 1).
The survey within the framework of our study showed
that if in the 1st group the frequency of mild urinary
incontinence was 1.5 times less than in the 2nd (60 and
40.6%), then in the 1st group the frequency of
moderate and severe urinary incontinence was 1.5 and
2 times more (41.4 and 15%, respectively).
In our study, we were surprised by the high percentage
of women (>90%) who sought medical attention for
urinary incontinence after the examination. We found
that less than 5% of women who sought medical
attention received pelvic floor exercises, medication,
or surgery for their urological problems.
The data suggest that various types of urinary
incontinence can interfere with daily activities. In our
study, the prevalence of urinary incontinence was
20.7%, which was close to the literature data of 29%.
Thus, it is necessary to conduct further research,
develop new methods of diagnosis, prevention,
therapy and rehabilitation, the solution of which will
reduce the development of the disease and help
improve the quality of life of women of reproductive
age.
CONCLUSIONS
Thus, the obvious positive dynamics of the quality of
life of patients after surgical treatment proposed for
cystocele, urinary incontinence, can be explained by
the high efficiency of urinary incontinence treatment in
our study and the relatively low frequency of
postoperative complications. Compared with the data
of many studies in recent years, according to which the
success of operations ranged from 87 to 95%, the
efficiency of surgical treatment of urinary incontinence
in our study was 96.3%.
REFERENCES
1.
Krasnopolskaya I.V., Popov A.A., Tyurina S.S.,
Fedorov A.A., Slobodanyuk B.A., Manannikova
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T.N., Barto R.A., Golovin A.A. Comparative analysis
of the use of transvaginal sacrospinal fixation and
laparoscopic sacrocolpopexy in the treatment of
patients with genital prolapse // Russian Bulletin of
Obstetrician-Gynecologist. - 2014. - No. 5 - P. 66-70.
2.
Korshunov, M.Yu. Evaluation of lower urinary tract
function in women after surgery for pelvic organ
prolapse: objective and subjective criteria / M.Yu.
Korshunov // Urological news. - 2013. - Vol. III, No. 2.
- P. 20-23.
3.
Nechiporenko, N.A. Genital prolapse. / N.A.
Nechiporenko, A.N. Nechiporenko, A.V. Strotsky //
Minsk: Higher School, 2014.
–
399 p.
4.
Wu, JM Lifetime risk of stress urinary incontinence
or pelvic organ prolapse surgery. / JMWu,
CAMatthews, MMConover et al. // Obstet.
Gynecol.-2014. - #123 (6).
–
p. 1201-1206
5.
Hendrix SL, Clark A, Nygaard I, et al. Pelvic organ
prolapse in the Women's Health Initiative: gravity
and
gravity.
Am
J
Obstet
Gynecol.
2002;186(6):1160-1166.
doi:
10.1067/mob.2002.123819.
6.
Kelly HA. Incontinence of urine in women. Urol
Cutan Rev. 1913;(17):291-293.
7.
Lensen EJ, Stoutjesdijk JA, Withagen MI, et al.
Technique of anterior colporrhaphy: a Dutch
evaluation. Int Urogynecol J 2011;22(5):557-561.
doi:10.1007/s00192-010-1353-4.
8.
Maher CM, Feiner B, Baessler K, Glazener CM.
Surgical management of pelvic organ prolapse in
women: the updated summary version Cochrane
review. Int Urogynecol J 2011;22(11):1445-1457.
doi:10.1007/s00192-011-1542-9.
9.
Rock, JA Te Linde's operative gynecology, 10th
Edition / JA Rock, HW Jones.
–
Lippincott Williams
& Wilkins, Philadelphia, USA.
–
2003.
–
P. 1470.
10.
Rooney, K. Advanced anterior vaginal wall
prolapse is highly correlated with apical prolapse /
K. Rooney, K. Kenton, ER Mueller // Am J Obstet
Gynecol.
–
2006.
–
Vol. 195.
–
P. 1837
–
1840.
11.
Roovers, JP Effects of genital prolapse surgery and
hysterectomy on pelvic floor function / JP Roovers,
MM Lakeman // Facts Views Vis Obgyn.
–
2009.
–
Vol. 1(3).
–
P. 194-207.
12.
Ross, JW Laparoscopic sacrocolpopexy for severe
vaginal vault prolapse: five-year outcome / JW
Ross, MJ Preston // Minim Invasive Gynecol.
–
2005.
–
Vol. 12(3).
–
P. 221
–
226.
13.
Assessment of symptoms of pelvic organ prolapse
using the short form of the UDI -6 questionnaire in
women
in
Uzbekistan.
Yuldasheva
D.Yu.,
Usmanova B.I., Chorieva G.Z. et all. Art of Medicine
International Medical Scientific Journal. Volume-3.
Issue-1. 2023. P.147-152.
