Pelvic floor static disorder constitutes a significant clinical and social problem. The symptoms worsen when intra-abdominal pressure increases, for instance during physical activity or coughing. The number of patients with pelvic organ prolapse is not exactly known due to different definitions of the disorder and various systems of classification. According to the latest European data, the problem concerns approximately 6–11% of women. According to American data, the disorder is found in about 24% of women. The incidence of the problem increases with the age of female patients up to 80 years of age. In such cases, the need to perform surgery is determined in 20% of women [1, 2, 3].
1.1. Surgical treatment
Currently, the basic indication for surgical treatment is the occurrence of symptoms and the lack of consent of the patient for conservative treatment. The most common symptoms are:
strain and/or pain in the lower abdomen;
urinary and/or faecal incontinence;
recurrent bladder ailments (urinary urgency or pollakiuria);
difficulty urinating and/or defecating;
the need to change body position in order to urinate;
limited sexual activity [4].
Due to various methods of procedural treatment, eligibility for surgery should be carefully discussed with the patient. Ideally, the surgery should be effective, applicable in patients with a positive family history and with the least possible number of complications.
In 1990, A. Wattiez [5] performed the first laparoscopic sacrocolpopexy, which is a gold standard for treating pelvic floor static disorders. The surgery involves the reconstruction of pelvic fascia using an implant. The Y-shaped back mesh is attached to the puborectalis and above, to the vaginal stump or the uterine cervix, while the front mesh is affixed below the vesical trigone. Both mesh implants are joined and after opening the peritoneum they are stitched to the longitudinal ligament of the vertebral column. Then, the peritoneum is closed over the mesh [6].
The surgery gives very good treatment results in the absence of complications typical for vaginal mesh implants. Unfortunately, due to the fact that the patient is in the Trendelenburg position during surgery and on account of the long surgery time of approximately 180 minutes [7], laparoscopic sacrocolpopexy is not a solution that can be performed on every patient.
Therefore, new solutions have appeared, such as Noe's [8] pectopexy (the suspension of the Cooper's ligament) and the Dubuisson's laparoscopic lateral suspension [9].
However, it seems that in case of history of internal diseases, older patients for whom laparoscopic or abdominal surgeries under general anaesthesia may pose too high risks, the only alternative is transvaginal surgery. Then, the vaginal suspension to the sacrospinous ligament, developed by Amreich in 1951 [10], and then modified by Sederl and Richter, [11] should be considered. This method involves putting stitches on the sacrospinous ligaments after it becomes visualised. According to the latest scientific reports, this method is less effective than sacropexia. Moreover, frequent recurrences after surgery and rather common problems with ligament visualisation [12] made it necessary to introduce a method which would combine low invasiveness of transvaginal surgery with high efficiency.
Transvaginal surgeries performed under block anaesthesia, with the use of synthetic materials, giving good results in most studies [13], seemed to be a good solution.
However, due to the possibility of complications, such as mesh erosion and pain associated with its implantation, in 2011, the U.S. Food and Drug Administration (FDA) issued a warning, and in 2019 withdrew the vaginal mesh implants from the US market [14].
Complications related to the use of the mesh include the possibility of its erosion, which can be avoided by using small mesh implants with a monoporous texture that reduce the burden of biomaterials. Due to the preparation and attachment of the mesh near the pudendal nerve and pudendal vessels, the possibility of damage to the above structures, including neuralgia or haemorrhage may arise [15].
Despite the uncertainties presented above concerning the performance of the surgery of an isolated apical defect using synthetic materials, it seems that the procedure is justified, especially in elderly patients, who have a history of internal diseases.
According to available data, 11% of women over the age of 65 have sexual intercourse. Moreover, about 52% of seniors would like to engage in sexual intercourse at least once a week or every day, but only 40% have had sexual intercourse once during the last year [16]. This is caused by physiological and psychosocial, but also medical factors. It is worth mentioning that reconstructive treatment with polypropylene mesh implantation allows the patients to have sexual intercourse, as opposed to, for instance, the Neugebauer-Le Fort method, which involves partial or complete closure of the vagina. The greatest advantages of surgeries using synthetic mesh implants include the possibility of using them in patients with history of internal diseases due to the use of block anaesthesia or, in case of specific anaesthetic contraindications, short intravenous or infiltration anaesthesia. Another advantage is the procedure time, which is about 30 minutes, and short hospitalisation time, allowing patients to leave the hospital as early as 24 hours after surgery [17].
1.2. Quality of life of patients with pelvic floor static disorders
The problem, which greatly decreases the quality of life of patients with pelvic floor static disorders, are symptoms of micturition disorder [18]. They mainly include incomplete bladder voiding, chronic urine retention, interrupted or impeded urination, as well as the need to support urination by engaging the abdominal prelum or the need to change body position in order to urinate. Some patients with complete uterine prolapse must manually relocate the prolapsed reproductive organ to urinate. Pelvic floor static disorders significantly impede basic life activities such as walking. It is also not uncommon for painful abrasions, bedsores and hernial sac ulcers to appear. However, there are still no scientific reports assessing the efficacy of the method, particularly in terms of improving the quality of life of patients undergoing the procedure [19].
Currently, in the process of treatment, in addition to achieving medical goals, the non-medical ones, which include improving the patient's well-being and quality of life, play an important role. Indeed, it is the assessment of quality of life that proves the holistic approach to the patient and their problem [20]. When assessing quality of life, two aspects must be taken into account: the subjective and the objective one. Subjective assessment of the quality of life is primarily based on an interview. Unfortunately, such assessment will depend on the patient's mental state, her preferences, value system and personality traits. Objective assessment of quality of life is most frequently carried out by means of standardised questionnaires. Questionnaires are a valuable and repeatable tool for measuring the quality of life of patients [21, 22].
According to the World Health Organisation Quality of Life (WHOQOL), quality of life means an individual's perception of their position in life in the context of the culture and value systems in which they live. The quality of life is primarily influenced by physical health, interpersonal contacts and environmental characteristics [23, 24]. Nowadays, doctors not only focus on extending the life of their patients, but also on improving its quality. Contemporary medicine aims to improve the quality of life of the patient to the condition from before the disease. Therefore, researchers are increasingly interested in assessing quality of life of people affected by various diseases [25, 26].
The objective of this study was to assess quality of life of patients before and after performing the surgery of an isolated apical defect using synthetic materials.