- The State of the Vaginal Biocenosis in women with genital prolapse
The State of the Vaginal Biocenosis in women with genital prolapse
HEALTH OF WOMAN. 2020.9-10(155-156): 100-106; doi 10.15574/HW.2020.155-156.100
Kaminskyi V. V.1,2, Chaika K. V.1,2, Lavreniuk Yu. V.1, Sumenko V. V.1
1Shupyk National Medical Academy of Postgraduate Education, USIR
2Kyiv City Center for Reproductive and Perinatal Medicine
The objective: to identify clinical and diagnostic features of vaginal biocenosis in women with genital prolapse (GP) and the need for its correction.
Materials and methods. The study involved 120 patients with GP of grade 1-2 who were divided into two groups. The treatment group (Group 1) consisted of 90 patients who were divided into three subgroups: 1a (n=30) with GP correction by platelet-rich autoplasma, 1b (n=30) with GP treatment by hyaluronic acid-based agent, 1c (n=30) with GP treatment using laser system CO2 (SmartXideDOT, DEKA, Italy). The experimental group (Group 2) consisted of 30 patients who underwent GP correction by training the pelvic floor muscles individually according to the standard method.
Results. The violations of the vaginal biocenosis were revealed in both study groups at the initial stages of GP formation. They were mostly due to the atrophic changes of the vaginal mucosa and in the form of bacterial vaginosis diagnosed according to Nugent’s criteria. At the initial stages of GP formation, there was registered an increase in the duration of vaginal biocenosis disorders in patients with GP on the background of urogenital disorders, which may be associated with concomitant somatic diseases, indicating the need to correct the biocenosis as an important component in the correction of initial forms of GP.
Conclusion. Thus, timely conservative treatment of GP will not only correct GP, but also improve the state of the vaginal biocenosis, which significantly affects the quality of life of women with genital prolapse.
Keywords: genital prolapse, vaginal microflora, vaginal atrophy, autoplasma, hyaluronic acid, CО2-laser.
REFERENCES
1. Balan VE, Smetnik VP, Ankirskaja AS i dr. 2006. Urogenital'nye rasstrojstva v klimakterii: Medicina klimakterija. Urogenital Disorders in Menopause: Menopause Medicine. Moskva, Litterra:217-90.
2. Ledina AV, Kulikov AJu. 2009. Kompleksnoe lechenie i profilaktika jestrogenzavisimyh urogenital'nyh rasstrojstv: klinicheskie aspekty i farmakojekonomicheskij analiz. Complex treatment and prevention of estrogen-dependent urogenital disorders: clinical aspects and pharmacoeconomic analysis. Pharmacoeconomics. (1):13-8.
3. Al-Baghdadi O, Ewies AA. 2009. Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-todate overview. Climacteric. 12(2):91-105. https://doi.org/10.1080/13697130802585576; PMid:19117185
4. Calleja-Agius J, Brincat MP. 2009. Urogenital atrophy. Climacteric. 12(4): 279-85. https://doi.org/10.1080/13697130902814751; PMid:19387880
5. Sola V, Pardo J, Ricci P, Guiloff E. 2006. Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair. Int. Braz. J. Urol. 32(4):410-4; discussion 415. https://doi.org/10.1590/S1677-55382006000400005; PMid:16953907
6. Digesu GA, Khullar V, Cardozo L, Salvatore S. 2005. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapsed. Int. Urogynecol. J. Pelvic. Floor. Dysfunct. 16(3):176-81; discussion 181. https://doi.org/10.1007/s00192-004-1225-x; PMid:15875234
7. Pinos A. 2007. The Proceedings of the 7th Workshop of the International Menopause Society. Climacteric. 10(2):1-124. https://doi.org/10.1080/13697130701621027
8. Zheleznaja AA, Cvjashko TI, Knurov IJu, Shapovalov AG, Petrov AG, Luneva NN. 2016. Priminenie Obogashhennoj trombocitami autoplazmy v akushersko – ginekologicheskoj praktike. Application of platelet-rich autoplasma in obstetric and gynecological practice. Medical and social problems of the family. 21(1):76.
9. Everts P, Knape JA, Weibrich G et al. 2006. Platelet-rich plasma and platelet gel: a review. J. Extra. Corpor. Technol. 38(2):174-87.
10. Mahmedzhanova FN. 2013. Urofloumetrija pri disfunkcijah mocheispuskanija u zhenshhin. Uroflowmetry for urinary dysfunction in women. Gynecology. 15(1):76-8.
11. Zerbinati N, Serati M, Origoni M et al. 2015. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers in medical science. Lasers. Med. Sci. 30(1):429-36. https://doi.org/10.1007/s10103-014-1677-2; PMid:25410301
12. Smirnova MJu, Stroev JuI, Huaypu DA, Shlykova AB. 2006. Nedifferencirovannye displazii soedinitel'noj tkani i ih znachenie v akushersko-ginekologicheskoj praktike (obzor literatury). Undifferentiated connective tissue dysplasias and their importance in obstetric and gynecological practice (literature review). Saint Petersburg University Bulletin. (4):3-9.
13. Cox C, McKenna JP, Watt AP, Coyle PV. 2015. New assay for Gardnerella vaginalis loads correlates with Nugent scores and has potential in the diagnosis of bacterial vaginosis. J. Med. Microbiol. 64(9):978-84. https://doi.org/10.1099/jmm.0.000118; PMid:26296660
14. Allsworth JE, Peipert JF. 2007. Prevalence of bacterial vaginosis. Obstet. Gynecol. 109(1):114-20. https://doi.org/10.1097/01.AOG.0000247627.84791.91; PMid:17197596
15. Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. 2002. Definition of a type ofabnormal vaginal flora that is distinctfrom bacterial vaginosis: aerobicvaginitis. BJOG. 109(1):34-43. https://doi.org/10.1111/j.1471-0528.2002.00432.x; PMid:11845812
16. Verstraelen H. 2008. Cutting edge: thevaginal microflora and bacterial vaginosis. Verh. K. Acad. Geneeskd. Belg. 3(70):147-74.
17. Uvarova EV, Sultanova FSh. 2002. Vlagalishhe kak mikrojekosistema v norme i pri vospalitel'nyh processah genitalij razlichnoj etiologii. The vagina as a microecosystem in health and in inflammatory processes of the genitals of various etiologies. Gynecology. (4):189-95.
18. Barber MD, Walters MD, Bump RC. 2005. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am. J. Obstet. Gynecol. 193(1):103-13. https://doi.org/10.1016/j.ajog.2004.12.025; PMid:16021067
19. Due U, Brostrom S, Lose G. 2013. Validation of the Pelvic Floor Distress Inventory-20 and the Pelvic Floor Impact Questionnaire-7 in Danish women with pelvic organ prolapse. Acta. Obstet. Gynecol. Scand. 92(9):1041-48. https://doi.org/10.1111/aogs.12189; PMid:23725572