Prolapse of the pelvic organs. The Saba Nahedd procedure of attaching the uterine isthmus with strip at the the rectus abdominis muscle sheath. Anatomic success and subjective cure rates on a series of 103 cases

O.C. Ionescu, N. Bacalbașa, N. Saba, G. Bănceanu

Abstract: The surgical treatment of prolapse of the pelvic organs (POPs) is indicated in women with prolapse-associated symptoms such as pelvic pains (PPs), obstructive voiding (OV), constipation or bulge symptoms. Our aim was to investigate anatomic success and cure rates of the surgical technique of attaching the uterine isthmus with two strips at the lateral and medial extremities of the rectus abdominis sheath. The technique has been developed by Saba Nahedd and has been applied on 103 cases of apical prolapse grades I-IV and/or cystocele per magna and/or rectocele. Our study consisted of 103 patients aged between 31 and 81 years who were diagnosed between 2013 and 2018 with symptomatic apical prolapse of stages I-IV and/or cystocele per magna and/or rectocele. The pelvic organ prolapse quantitation system has been applied for the classification of the apical prolapse. For the other vaginal compartments we used the traditional definitions of cystocele per magna. In order to obtain informations related to one or another vaginal compartment we have used a questionnaire of examination at the presentation in which the patients have been asked about their symptoms. The questionnaire was applied at one, three, six and twelve months to see if recurrences and relief of symptoms have been obtained or not. We applied descriptive statistics and a nonparametric test-the Mcnemar to see the significance of the symptoms relief in the immediate postoperative period as well as at one, three, six and twelve months. We have also evaluated the postoperative complications, the rate of apical prolapse recurrence as well as the impact on the rates of cystocele and rectocele. The results showed a statistically significant decrease in the rates of PPs, pelvic pressure symptoms, constipation and OV at one, three, six and twelve months after surgery compared to the symptoms reported at the initial presentation. The rate of apical prolapse recurrence was 2.9%. Significant changes in the rates of cystocele per magna and rectocele have also been reported. Almost 35.92% reported the resumption of the sexual activity after 12 months compared to 0.97% at one month. The uterine-sparing procedure developed by S.N allows the reestablishment of the normal pelvic anatomy and has resulted in high anatomic success and subjective cure rates. However, the patients should be informed on the benefits and risk of the POPs procedure compared to other techniques that imply a concomitant vaginal hysterectomy.
DOI:10.18643/gieu.2018.27

Keywords: apical prolapse, pelvic pain, constipation, recurrence.