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Background. Colpoptosis combined with stress urinary incontinence is one of the most common conditions in postmenopausal women. Menopause is also associated with the risk of genitourinary syndrome due to estrogen deficiency. Despite the variety of options for surgical correction of genital prolapse and urinary incontinence, there is no universal technique. The use of vaginal approach in pelvic floor surgery is associated with several controversies regarding the rates of recurrence and mesh-associated complications. Studies of the state of the endothelium in menopause have demonstrated a close relationship between age-related features and the frequency of adverse clinical outcomes, which requires an optimal intervention not only on the hormonal status but also on the microcirculatory system. Aim. To improve the principles of complex treatment of pelvic organ prolapse and genitourinary syndrome in postmenopausal patients. Materials and methods. The study included 48 postmenopausal patients with genital prolapse of stage II and above according to the POP-Q classification. All patients received continuous menopausal hormone therapy (MHT) with a combined estrogen-progestogen agent. The patients in group 1 (n=24) received MHT according to clinical guidelines for managing patients with genitourinary syndrome. The patients in group 2 (n=24), in addition to MHT, received sulodexide containing glucurono-2-amino-2-deoxyglucoglucan sulfate before the intended surgical treatment and for 30 days after surgery. Correction of colpocystocele, proctocele and stress urinary incontinence was performed using anterior and posterior colporrhaphy, perineoplasty, and urethral sling placement in case of stress urinary incontinence. Results. Six months after surgical treatment, signs of genital prolapse recurrence were detected in 3 patients (12.5%) in group 1, and 1 patient (4.2%) showed signs of mesh-associated complications (implant extrusion) after urethral sling placement. In group 2, only 4.2% of patients (n=1) showed signs of recurrence of stage II cystocele. All patients who underwent urethral sling surgery reported improved urinary incontinence (n=10). During complex therapy, 3 months after surgery, a more significant improvement of endothelial dysfunction markers was noted in group 2 patients (homocysteine level in group 1 after treatment was 12.27±0.34, in group 2 – 8.34±0.24). Conclusions. Combination therapy of genitourinary syndrome and genital prolapse using MHT, endotheliotropic drugs and vaginal surgical approach in postmenopausal patients contributes to effective and safe treatment associated with minimal risk of complications and recurrence rate. Endothelial dysfunction correction is an essential step in planning surgical intervention in menopausal patients, which contributes to improving tissue repair in the postoperative period.

Pelvic organ prolapse belongs to the group of multidisciplinary pathological processes, in the pathogenesis of which various etiological components are involved, leading to destabilization of ligaments and muscular-fascial system. In most cases, pelvic floor dysfunction requires surgical treatment, which allows eliminating defects and reducing clinical symptoms, also improving quality of life of patients. Performing surgeries for genital prolapse using laparoscopic approach is associated with high efficiency and low risk of unfavorable clinical outcomes. However, despite significant progress and improvement of surgical treatment options, the choice of the rational treatment in terms of a personalized approach remains relevant. This literature review analyzes classical and alternative modes of laparoscopic correction of pelvic organ prolapse.

Pelvic organ prolapse refers to a group of multidisciplinary disorders with various etiological components involved in its pathogenesis, destabilizing the ligamentous and musculofascial apparatus. In most cases, pelvic floor dysfunction requires surgical treatment, eliminating existing defects and clinical symptoms and improving patients' quality of life. Corrective surgery for genital prolapse by laparoscopic approach is highly effective and is associated with a low risk of adverse clinical outcomes. However, despite the significant progress and improvement of surgical treatment options, choosing the optimal treatment method based on a personalized approach remains an urgent issue. This literature review reviews traditional and alternative methods of laparoscopic correction of pelvic organ prolapse.