This article presents a new surgical technique for the correction of combined form of pelvic organ prolapse (POP) characterized by anterior vaginal wall prolapse (bladder prolapse or cystocele), urethral hypermobility, and stress urinary incontinence in women aged 59–75 years using personalized titanium implants with the original, mesh-ligature-“anchor” transobturator-sacrospinous-prepubic method of fixation. To date, 11 surgeries have been performed using this technique. Conclusion. The developed surgical technique for the correction of combined form of POP improves safety and optimizes the results of surgical treatment, minimizes intraoperative and mesh-related complications, and reduces disease recurrence. Key words: titanium implants, anterior vaginal wall prolapse, combined forms of pelvic organ prolapse, transobturator-sacrospinous-prepubic method of implant fixation

Objective. To conduct a comparative analysis of the efficacy of different surgical techniques for the correction of grade II–III anterior vaginal wall prolapse in sexually active patients of reproductive and perimenopausal ages. Patients and methods. The study included 79 patients of reproductive and perimenopausal ages with grade II–III anterior vaginal wall prolapse. All patients were divided into three groups depending on surgical technique: group 1 (n = 25) – surgical correction of prolapse using titanium mesh implants and 4 soft tissue fixators (“anchors”) according to the developed original technique; group 2 (n = 26) – surgical correction of prolapse using standard polypropylene implants; group 3 (n = 28) – correction with native tissues only. Results. At 1 month after surgery, about 50% of patients in each group reported irregular crampy pain in the inguinal and femoral region and/or perineum. Frequent urination was observed in 20% of patients in group 1, in 23% in group 2 and in 21.4% in group 3. At 6 and 12 months after surgery, 19.2% of patients in group 2 complained of bloody vaginal discharge, vaginal discomfort, painful intercourse, and partner’s negative reaction due to painful intercourse. Gynecological examination revealed erosion in the anterior vaginal wall and endoprosthesis extrusion, which required partial excision of the implant followed by restoration of the integrity of the anterior vaginal wall. Recurrence of grade II–III genital prolapse was diagnosed in 24–36 months in 25% of patients in group 3, in 7.7% in group 2, and in 1 (4%) in group 1, which did not require repeat surgical intervention. Conclusion. The use of individually sized titanium mesh implants together with titanium fixators (“anchors”) for the correction of grade II–III anterior vaginal wall prolapse is preferable to other surgical techniques. Key words: grade II–III anterior vaginal wall prolapse, surgical correction, titanium and polypropylene mesh implants, reproductive and perimenopausal period, mesh-related complications, disease recurrence

Objective. To study the efficacy and safety of the original surgical technique for the correction of grade 2 anterior vaginal wall prolapse using a combination of titanium mesh implants and non-absorbable anchor ligatures in reproductive-aged patients. Patients and methods. The results of examination and treatment of 12 reproductive-aged patients (35–43 years old) with grade 2 anterior vaginal wall prolapse, operated according to the original technique using a combination of titanium mesh implants and non-absorbable anchor ligatures, were analyzed. Results. Patients were followed up at 1, 3, 6, 12 months after surgery. Comparison of patient questionnaires in the pre- and postoperative periods showed improvement of quality of life and satisfaction with the results of surgical intervention. During the first month, 4 out of 12 patients reported mild cramping pain in the lower abdomen, 3 patients – frequent urination. Comprehensive clinical examination after 3, 6, 12 months revealed complete preservation of the results of surgical correction of anterior prolapse in all patients. Gynecological examination, transperineal and transvaginal ultrasound showed no displacement of pelvic organs and titanium implants. There were no Mesh-associated complications during the follow-up period. Conclusion. The efficacy and safety of the developed surgical technique for the correction of grade 2 anterior vaginal wall prolapse using a combination of titanium mesh implants and non-absorbable anchor ligatures in reproductive-aged patients were demonstrated. However, a small patient cohort indicates the need to continue research in this direction. Key words: grade 2 anterior vaginal wall prolapse, reproductive age, titanium mesh implants, non-absorbable anchor ligatures, trans-obturator Timesh-ligature correction

Objective. To study the efficacy and safety of combined (laser + electromyostimulation + pelvic floor muscle training) nonsurgical correction of pelvic organ prolapse (POP) recurrences in the late postoperative period in reproductive-aged, pre- and postmenopausal patients with different types of POP. Patients and methods. A comprehensive clinical examination, surgical treatment, and dynamic outpatient follow-up (at 1, 6, 12, 24, 36, and 48 months) of 523 patients with different types and severity of POP were performed. Disease recurrences were diagnosed in 69 (13.2%) women, 52 of whom underwent a combined non-surgical corrective therapy (laser + electromyostimulation + pelvic floor muscle training) with subsequent efficacy evaluation after 6 and 12 months. Results. Postoperative recurrences of POP were most often observed 12–36 months after surgical intervention using only own tissues (26.6%), less frequently – when synthetic implants were used (12.7%) and, extremely rarely, when titanium endoprostheses were inserted (1.6%). The positive effect of combined non-surgical correction in 32 (61.5%) women was expressed in a lower number and intensity of symptoms, improvement in the quality of life according to the PFDI-20 scale, optimization of gynecological examination data and quantitative parameters according to the POP-Q classification system. Conclusion. Combined non-surgical therapy (laser + electromyostimulation + pelvic floor muscle training) for postoperative recurrences of POP contributed to the optimization of clinical picture, dynamic improvement of the quantitative parameters of postoperative prolapse according to the POP-Q classification system, improvement of the quality of life of women, their social and sexual rehabilitation, which demonstrates the efficacy and safety of the implemented therapeutic program. Key words: postoperative recurrences of pelvic organ prolapse, combined non-surgical therapy, fractional CO2 laser, electromyostimulation, pelvic floor muscle training

Objective. To study the efficacy and safety of the original surgical instrument for trans-obturator insertion of ligatures and tapelike implants in patients with pelvic organ prolapse (POP) and stress urinary incontinence (SIU). Patients and methods. This study included 164 patients with POP and urethral hypermobility aged 34–79 years. The original threecomponent surgical instrument for trans-obturator insertion of ligatures and tape-like implants (Patent No. 217079, 2022) was used during surgery. Four developed surgical programs using titanium mesh implants and non-absorbable ligatures were implemented. Results. Patient questionnaire showed satisfaction with the results of surgical treatment in all cases, which had a positive effect on the quality of life, mood and contributed to an increase in social activity. Patients of reproductive age and in perimenopause reported an improved quality of sexual life. The recurrence of first-degree POP in the late postoperative period was diagnosed after 12–36 months in 5 patients (4.8%), but it did not require surgical re-intervention. Conclusion. Clinical approbation of the developed three-component instrument for trans-obturator insertion of ligatures and tape-like implants in patients with different degrees of POP and SIU confirmed its effectiveness and safety. The undoubted advantages of this instrument include convenient assembly, simple postoperative processing and sterilization, as well as the possibility of multiple use and, therefore, economic benefit, which, together with other useful parameters, makes this instrument universal for this type of surgery. Key words: gynecological surgical instrument, trans-obturator insertion of ligatures, tape-like implants

This article presents a clinical case of giant serous papillary cystadenoma in a 35-year-old patient with secondary infertility. The patient underwent successful surgical treatment, and reproductive potential was restored. Key words: giant serous cystadenoma, secondary infertility, reproductive age, surgical treatment

This article presents an original method of surgical treatment of complete uterine prolapse (a modification of the Neugebauer–Le Fort operation) in elderly and senile patients using titanium tape mesh implants, which contribute to strengthening and firm consolidation of the vaginal walls, elevation and stabilization of the postoperative position of pelvic organs (uterus, vaginal walls, bladder). Key words: complete uterine prolapse, elderly and senile age, modification of Neugebauer–Le Fort operation, titanium implants

Ovarian vein thrombosis (OVT) is a rare but potentially serious complication associated with a variety of conditions, including past childbirth, inflammatory diseases, malignant processes, and pelvic surgery. The aim of this study is to summarize the literature on this problem and to analyze the frequency, differential diagnosis, and management of OVT. The article highlights three observations of ovarian vein thrombosis and thrombophlebitis diagnosed after spontaneous and operative vaginal deliveries. Key words: pregnancy complications, postpartum period, thrombosis, thrombophlebitis, ovarian vein

This article presents two clinical cases of infiltrative scar endometriosis after cesarean delivery and episiotomy at spontaneous vaginal delivery. The infiltrative form of post-operative scar endometriosis is an indication for surgical treatment, presenting a complicated surgical challenge due to the extent of infiltration and involvement of the surrounding tissues. The restoration of the infiltration area also poses certain difficulties. For this purpose, mesh implants are used to help replace and reconstruct the tissues of the anterior abdominal wall and therefore reduce the risk of post-operative hernia formation. Key words: infiltrative scar endometriosis, diagnosis, surgical treatment, mesh implant

This article presents the results of surgical treatment of 3 patients aged between 35 and 42 years with stage II anterior vaginal wall prolapse who underwent a trocar-less transobturator correction of anterior prolapse with titanium mesh implants of individual sizes according to a newly developed technique using titanium fixators. The efficacy and safety of the new trocar-less surgical technique for correcting stage II anterior vaginal wall prolapse in patients of reproductive age using titanium implants and fixators were demonstrated. Conclusion. The trocar-less fixation of titanium implants of individual sizes using 4 titanium fixators, their combination with non-absorbable ligatures into a single functional unit, and multifocal fixation of implants contribute to the normalization of anatomic position of pelvic organs, relief of anterior prolapse symptoms, lower risk of injuries to obturator vessels and nerves, and lower incidence of mesh-related complications. Key words: pelvic organ prolapse, TiMesh-ligature colpopexy, trocar-less transobturator correction, titanium fixators

The aim of this research was to analyze the literature on uterus transplantation. The features of the preoperative preparation were presented: recipient and donor selection, surgical aspects of uterus transplantation, postoperative complications and rehabilitation period management, choice of immunosuppressive medications. Special attention was paid to the restoration of fertility and reproductive function in uterus recipients. The results of uterus transplantation from a living donor and a deceased donor in different countries of the world – Germany, USA, Brazil, China were studied. The study shows that although the number of uterus transplants has reached 52 by 2021, this procedure is still not routine and is experimental. Key words: infertility, Mayer-Rokitansky-Küster-Hauser syndrome, uterus transplantation

This review presents the analysis of literature which reveals the role of various factors contributing to the development of pelvic organ prolapse in women. The role and significance of factors leading to elevated intra-abdominal pressure, including obesity, are discussed. The effect of natural childbirth on the structure and function of pelvic floor is assessed. A current perspective on the influence of estrogen levels on the structure and properties of pelvic connective tissue in women is presented. The issue of metabolic and structural disorders of collagen in the development of pelvic organ prolapse as well as the role and significance of hereditary connective tissue disorders in the genesis of this disease are considered separately. The connection between pelvic surgeries such as hysterectomy and the subsequent development of pelvic organ prolapse is traced and analyzed. Particular attention is paid to the analysis of the effectiveness of surgical treatment for pelvic organ prolapse, also data on the use of mesh materials is provided, and the possibility of increasing the efficacy of surgical treatment by improving surgical techniques and using promising synthetic materials with stem cells is discussed. Key words: pelvic organ prolapse, hereditary connective tissue disorders, recurrence, pelvic floor, birth-related perineal trauma, risk factors for pelvic organ prolapse, surgical correction

The analysis of clinical observation of 4 patients aged 68–78 years with post-hysterectomy pelvic hernia who were operated with the use of titanium implants and transobturator ligature fixation of the vaginal cuff according to the original technique is presented. Dynamic follow-up for 3–12 months after surgery showed the absence of pelvic organ prolapse during gynecological examination, Valsalva maneuver, and transperineal ultrasound. The questionnaire survey of patients showed their satisfaction with the results of surgery and improvement of their quality of life. Conclusion. Median TiMESH colporrhaphy with transobturator ligature fixation of the vaginal cuff in patients of elderly and senile age with post-hysterectomy pelvic hernia when slightly prolonging the operation duration contributes to strengthening and firm consolidation of the vaginal walls, elevation of the vaginal cuff and adjacent organs, improving the condition of the surgical scar and, therefore, improving patients’ quality of life and preventing disease recurrence. Key words: post-hysterectomy pelvic hernia, median TiMESH colporrhaphy, transobturator ligature fixation of the vaginal cluff

Objective. To study the efficacy and to assess the safety of the use of titanium ribbon-like implants for surgical correction of various forms of apical prolapse. Patients and methods. 23 patients with apical prolapse (stage III–IV) aged 29 to 74 years were examined. Surgical correction of various forms of apical prolapse was performed using titanium ribbon-like mesh implants, which are more inert to the surrounding tissues than polypropylene scaffold systems. Dynamic outpatient observation of the patients was carried out after 3, 6, 12, 15 months after surgery. Results. The duration of surgery varied from 55 to 80 minutes, on average 74 ± 11.5 minutes. Intraoperative blood loss ranged from 50 to 150 mL (100 ± 35.7 mL). Of the early postoperative complications, only hematomas in the projection of the posterior vaginal wall of small sizes (up to 10 ml) – 2 (8.7%) were noted. Comparison of the questionnaire data from patients in the preand postoperative period showed an improvement in the quality of life of patients, an increase in their social and sexual activity. There was no significant displacement of the pelvic organs, and there were no mesh-associated complications. Conclusion. Laparoscopic bilateral subperitoneal hystero-, cervico-, colposuspension to the aponeurosis using titanium mesh ribbon-like implants improves the efficiency of surgical treatment of various forms and severity of apical prolapse. Key words: apical prolapse, hysterosuspension, titanium mesh implants

Clinical observation of two patients with polyvalent allergy, uterine leiomyoma, and stage II apical prolapse who underwent a combined surgical intervention of subtotal/total hysterectomy followed by cervical stump/vaginal stump promontofixation using titanium mesh implants. Dynamic follow-up for 3–12 months after surgery showed the absence of pelvic organ prolapse during gynecologic examination, Valsalva maneuver, and transperineal ultrasound. A questionnaire survey of the patients revealed satisfaction with the results of surgery and improvement of the quality of life. Conclusion. The study demonstrated the efficacy and safety of combined laparoscopic surgery for uterine leiomyoma and stage II apical prolapse in premenopausal patients with polyvalent allergy. The surgery contributed to the normalization of anatomical relations in the small pelvis and relieving the apical prolapse symptoms. The use of titanium mesh implants minimized the risk of allergic reactions and mesh-associated complications, which resulted in satisfaction with the results of surgery and improvement in the quality of life of the patients. Key words: pelvic organ prolapse, apical prolapse, hysterectomy, titanium mesh implants

The analysis of literature data on molecular mechanisms for remodeling of connective tissue of the female reproductive system during pregnancy, childbirth and in the postpartum period is presented. The search for publications and their analysis was conducted in PUBMED, Google Scholar, eLIBRARY.RU databases. Particular attention was given to the study of expression pattern of specific proteinases involved in the process of synthesis and combination of elastic fibers, assembly of the collagen polypeptide chains at different stages. The place of matrix metalloproteinases and their tissue inhibitors in proteolytic degradation of the extracellular matrix of connective tissue is described. Pregnancy, childbirth and postpartum period are the triggering mechanism for connective tissue remodeling, certain mechanisms of which remain unclear and require further investigation. Key words: collagen, lysyl oxidase, metalloproteinases, сonnective tissue, fibulin-5, extracellular matrix, elastic fibers

Objective. To improve the technique for cesarean section and reduce the incidence of postoperative complications using selflocking surgical (anchor) sutures. Design and results. The study involved 86 patients who underwent cesarean delivery at the age from 18 to 40 years, similar in demographic parameters, somatic status, parity, pregnancy complications and the number of cesarean sections in history. Two groups of patients were allocated: the first (main) group – 46 women, in whom a double-sided single-row suture with a selflocking suture anchor without reverse tip was used to repair a wound on the uterus (patent RU2729747C1); the second (comparison group) – 40 women; a double-row suture to repair the uterine wound involving multifilament sutures was used. For a number of characteristics (the duration of operation, the duration of suturing of the uterus, the restoration of physical activity during the first day, the need for analgesics, the activity of reparative processes in the myometrium), the advantage of a singlerow suture anchor was noted. Conclusion. The developed method provides conditions for the activation of reparative processes in the myometrium and potentiates rapid rehabilitation of patients after surgery. However, further research is needed to introduce the method into widespread clinical practice. Key words: cesarean section, incompetent uterine scar, isthmocele, double-sided single-row suture, self-locking suture anchor

Objective. To study the effectiveness and safety of new surgical method for correcting the anterior vaginal wall prolapse using tissue-engineered constructs. Patients and methods. After preliminary experimental work on the creation and evaluation of the biocompatibility of tissueengineered constructs based on non-biodegradable (polypropylene and titanium endoprostheses) mesh implants with an autologous cellular component (rat and human dermal fibroblasts), 4 patients aged 44, 54, 70 and 75 years were examined. Inclusion criteria: anterior vaginal wall prolapse (stage II – III); consent to the installation of tissue-engineered construct. A fourstage surgical program providing for the correction of stage II-III anterior vaginal wall prolapse using tissue-engineered constructs of individual size was used. Results. In the early postoperative period, one patient was diagnosed with a small hematoma of the anterior vaginal wall. During the first month after surgery, one patient complained of gradual perineal pain, another patient – of frequent urination. Subsequently, these symptoms stopped. After 3, 6, 9, 12, 15 months after surgery, during the pelvic examination at rest, the Valsalva maneuver and transperineal ultrasound, no displacement of organs was detected, ultrasound clearly visualized a tissueengineered construct without displacement and deformation. Conclusion. We have developed an original method for correcting the prolapse of the anterior vaginal wall using tissueengineered constructs based on polypropylene and titanium with an autologous cellular component, which helps to optimize the results of surgical treatment, reduce the frequency of disease recurrence and the risk of developing mesh-related complications. Key words: pelvic organ prolapse, tissue-engineered constructs, surgical correction

Introduction. Prolapse of pelvic organs is a polyetiological disease, manifested by a displacement of the uterus and he vaginal walls to the genital slit and/or by going beyond it. The urgency of the problem of prolapse of pelvic organ is associated with a tendency for an increase of morbidity in both elderly women due to increased expectancy of life and women of the reproductive period. Material and methods. The study included 62 patients, age of them was 4275 years. All women were underwent surgical correction with a transvaginal installation of the front mesh implant Gineflex with intraoperative extraction of fragments of the mucous membrane of the anterior wall of vagina with subsequent histological examination, as well as fragments of the mesh prosthesis after its installation and processing of the vaginal mucosa of the SmartXide2 V2LR laser system. Patients were separated on the two group taking into account the operating mode parameters of the fractional CO2 laser. In the 1st group, with a total laser energy of exposure 8.13 J/cm2, included 32 patients, in the 2nd, with a total laser energy of impact 1.48 J/cm2, 30 patients. Transvaginal installation of the anterior mesh prosthesis Gineflex was complemented such the surgical interventions as extraperitoneal ligature hysterosuspension, posterior colporography, colpoperineoplasty, installation of Urosling, Manchester operation, supravaginal uterine amputation, adnexectomy in depending on the accompanied pathology. Results. In the patients were determined IIIV stages of genital prolapse with using the POP-Q assessment system. During histological examination of a sample of biopsy of the vaginal mucosa, the thickness of walls ranged from 155 to 628 m. During microscopy on fragments of mesh prostheses in the 1st group, fragmentary destruction of the fibers of all formed was noted, which not have been detected in the examination of a samples of patients of the 2nd group, where the total laser energy was less on 6.65 J/m2. Conclusion. In patients with surgical correction of genital prolapse with using of a mesh implant upon the using the certain characteristics of SmartXide2 V2LR laser system for the exposure of the vaginal mucosa occurs partial destruction of the fibers of the mesh prosthesis, which allows to reduce the degree of tissue tension and consequently allows to reduce the level of complications after surgical diseases is associated with implantation a mesh prosthesis that does not reduce the effectiveness of this surgical treatment. This technique is safe, has no restrictions on the age and somatic status of patients, increases the tolerance of the postoperative period of surgical correction.