[Efficacy of vaginal stent and posterior pelvic reconstruction in the treatment of posterior vaginal wall prolapse with outlet obstruction constipation].

Abstract

Objective: To analyze the efficacy of vaginal stent placement and posterior pelvic reconstruction with transvaginal synthetic mesh implantation in the treatment of posterior vaginal wall prolapse with outlet obstruction constipation, and to explore the gynecological treatment strategy for the disease. Methods: Retrospective follow-up study. Totally 205 patients with posterior vaginal wall prolapse and outlet obstruction constipation treated with vaginal stent were selected from Shengjing Hospital Affiliated to China Medical University from September 2018 to August 2023. Among them, 16 patients (7.2%) did not continue the treatment (non-continuation group), and the remaining patients were divided into the continued vaginal stent treatment group (78 cases, 38.0%) and the posterior pelvic reconstruction group (127 cases, 62.0%) according to the subsequent treatment methods. The Pelvic Floor Distress Inventory Short Form (PDFI-20) and Obstructed Defecation Syndrome (ODS) questionnaire were used to evaluate the symptoms of defecation disorders before and after vaginal stent treatment. For the posterior pelvic reconstruction group, follow-up was performed at 3 months and 1, 2, 3, and 5 years after surgery. PDFI-20 and ODS questionnaire were used to evaluate the symptoms of defecation disorders at 3 months after surgery, and POP-Q was used to evaluate the anatomical reduction. Complications related to mesh implantation were followed up at 1, 2, 3, and 5 years after surgery. PDFI-20 and ODS scores before treatment and 1 month after intravaginal stent placement was compared, as well as between POP-Q points before surgery and 3 months postoperatively following posterior pelvic floor reconstruction. Results: A total of 205 patients, aged 65 (62, 68) years, were treated with vaginal stent. One month after vaginal stent treatment, the PDFI-20 questions 4, 7, 8, total score and ODS questions 1-8, total score of all patients significantly decreased (all P<0.05). In the posterior pelvic reconstruction group, the POP-Q indicator points Ap [2(2, 3) vs -3(-3, -3) cm] and Bp [3(2, 5) vs -3(-3, -2) cm] decreased significantly 3 months after the operation compared with those before the operation (all P<0.05), and the PDFI-20 questionnaire questions 4, 7, 8, total score and ODS questionnaire questions 1-8, total score all decreased compared with those before surgery (all P<0.05). During follow-up at 1, 2, 3, and 5 years after surgery, the anatomical reduction assessed by POP-Q was good, and the PDFI-20 questionnaire indicated satisfactory therapeutic effect. There were 5 cases of mesh exposure, 3 cases of pain and 1 case of prolapse recurrence. Conclusions: Vaginal stent placement provides experimental diagnosis and conservative treatment for outlet obstruction constipation, and provides a strong indication for posterior pelvic reconstruction surgery. Both vaginal stent placement and posterior pelvic reconstruction are effective for posterior vaginal wall prolapse with outlet obstruction constipation.