Prosthetic reconstruction of the pelvic floor using vaginal approach: contemporary view

The problem of the surgical treatment in female patients with pelvic organ prolapse and stress incontinence of the middle and elderly age group is very actual, given wide prevalence of the disease and the absence of the effective conservative treatment. This review is devoted to the actual state of prosthetic pelvic floor reconstruction. Uncomplicated stress urinary incontinence (SUI) is a place for active recommendations to implant the full-size midurethral slings, given the suboptimal efficacy of mini-slings. Transobturator slings fit ideally in case of concurrent urgency, retropubic slings - in case of internal sphincter insufficiency. Modern data from multicentric studies shows the strict practicability for using of synthetic endoprostheses in the anterior pelvic floor compartment (pronounced cystocele), which tends to decrease the risk of recurrence by a factor of 3 in comparison with traditional techniques. Available data reveals also the moderate advantages using the synthetic prostheses in the middle compartment of the pelvic flood (apical prolapse due to defect of the sacro-uterine ligaments). Nevertheless, the posterior compartment seems not to be better managed with synthetic devices compared to traditional surgery. Importantly, the operations should be done by experienced surgeons to prevent the implant-associated complications. The most pronounced benefit of the prosthetic reconstruction seems to be in the group of the patients with severe forms of the prolapse and high risk of recurrence. Our review will help the practical specialists to weight the advantages and disadvantages of the modern surgical methods in patients with pelvic floor diseases and eventually select the best treatment approach.