The Effect Of Transvaginal Pelvic Rconstructive Surgery On Pelvic Neuromuscular Function

[Objects] To evaluate pelvic neuromuscular function in the preoperative and postoperative 3 months of TVM by electroneurophysiological techniques and to discuss whether it can improve pelvic neuromuscular function or not when restoring anatomical structure at the same time; whether there is any difference influence on pelvic neuromuscular function of hysterectomy and hysteropexy; so as to provide theoretical basis for clinical application of TVM.[Methods] 1 The first part The effect of Total Vaginal Mesh Surgery on pelvic floor muscle functionThere are thirty-six staged Ⅲ~Ⅳ POP cases who need total vaginal mesh surgery, in which 20 are hysteropexy, and the other 16 are transvaginal hysterectomy. Their pelvic floor muscle functions are evaluated in the preoperative and postoperative 3 months of TVM with France PHENIXUSB4 neuromuscular stimulation therapeutic equipment respectively, and we compared the parameters before and after the surgery by paired t-test, which include the maximal voluntary contraction(MVC),Vaginal resting pressure(VRP)、fatigue and the strengths of typeⅡfibers、duration and the strengths of typeⅠfibers,etc.2 The second part The effect of Total Vaginal Mesh Surgery on pudendal nerve function There are sixty-eight staged Ⅲ~Ⅳ POP cases who need total vaginal mesh surgery,in which 31 are the hysteropexy, 18 are the trans-vaginal hysterectomy and the other 19 are the transvaginal hysterectomy. Their pudendal nerve functions are evaluated in the preoperative and postoperative 3 months of TVM with Solar Urodynamic Neuro Module, and we compared the parameters before and after the surgery by paired t-test, which include pudendal nerve terminal motor latency(PNTML)、amplitude.[Results] 1 The first part The effect of Total Vaginal Mesh Surgery on pelvic floor muscle functionThere exists statistical significance(P < 0.05) in the total vaginal mesh surgery group(36 cases) in preoperative and postoperative 3 months on pelvic floor muscle function of MVC, VRP, fatigue and the strengths of typeⅡfibers, but found no statistically significant significance(P﹥0.05) of the type I muscle fibers strength. There exists statistical significance(P < 0.05) in the hysteropexy group(20 cases) in preoperative and postoperative 3 months on pelvic floor muscle function of MVC, VRP, fatigue and the strengths of typeⅡfibers, but found no statistically significant significance(P﹥0.05) of the type I muscle fibers strength. There exists statistical significance(P < 0.05) in the transvaginal hysterectomy group(19 cases) in preoperative and postoperative 3 months on pelvic floor muscle function of MVC, VRP, fatigue and the strengths of typeⅡfibers, but found no statistically significant significance(P﹥0.05) of the type I muscle fibers strength.2 The second part The effect of Total Vaginal Mesh Surgery on pudendal nerve function 2.1 Relative factors analysis on pudendal nerve function of severe POPThere exists statistical significance(P < 0.05) in the differences of RPNTML、LPNTML between the severe POP and the health, also the absolute value differences between RPNTML and LPNTML of the severe POP(P < 0.05),but found no statistically significant significance(P﹥0.05) between RA and LA. using linear regression analysis the relevant factors of bilateral pudendal nerve terminal motor latency, the regression equation can be obtained as follows: RPNTML= 0.9 17+0.625LPNTML+ 0.049 VLPP, LPNTML =2.521 + 0.069 VLPP-0.04 1G. The right of pudendal nerve terminal motor latency in severe POP combined with stress urinary incontinence before surgery increased by at least 0.4ms than health person(2 standard deviations in our equipment), and 95% confidence interval is(0.45, 0.59) ms. The right of pudendal nerve terminal motor latency in severe POP recurrent SUI after TVM increased by at least 0.55 ms than health person(2.5 standard deviations in our equipment) and 95% CI is(0.55, 0.74) ms.2.2 The effect of different total vaginal mesh surgeries on pudendal nerve functionThere exists no statistical significance(P>0.05) in the total vaginal mesh surgery group(50 cases) in preoperative and postoperative 3 months on pudendal nerve function of RPNTML、LPNTML、RA、LA, also no statistical significance(P>0.05) in stage Ⅲ prolapsed or stage Ⅳ prolapsed.There exists no statistical significance(P>0.05) in the hysteropexy group(31 cases) in preoperative and postoperative 3 months on pudendal nerve function of RPNTML、LPNTML、RA、LA, also no statistical significance(P>0.05) in stage Ⅲ prolapsed.There exists statistical significance(P < 0.05) in preoperative and postoperative 3 months on pudendal nerve function of RPNTML, but no statistical significance(P>0.05) of LPNTML、RA、LA in stage Ⅳ prolapsed.And there exists no statistical significance(P>0.05) in the improving of pudendal nerve function amplitude DLPNTML、DRPNTML、DRA、DLAin the treating stage Ⅲ prolapsed and stage Ⅳ prolapsed.There exists no statistical significance(P>0.05) in the transvaginal hysterectomy group(19 cases) in preoperative and postoperative 3 months on pudendal nerve function of RPNTML、LPNTML、RA、LA, also no statistical significance(P>0.05) in stage Ⅲ prolapsed or stage Ⅳ prolapsed. And there exists no statistical significance(P>0.05) in the improving of pudendal nerve function of DLPNTML、DRPNTML、DRA、DLAin the treating stage Ⅲ prolapsed and stage Ⅳ prolapsed.[Conclusions] 1 TVM can promote the recovery of pelvic floor muscle function and is more beneficial to improvement of the typeⅡfibers whether to hysteropexy or transvaginal hysterectomy.2 TVM is effective to POP. It can avoid damage to the bilateral pudendal nerve in the process of treating severe POP if it is made in strict accordance with the recommended surgical route regardless of retaining the uterus or not. 3 There exists damage in the bilateral pudenal nerve of the severe POP, and the right side is severer than the left side; The average prolongation of right PNTML(2.1ms)of the nighty-five percent severe POP accompanying with SUI extends 0.4ms at least compared with the health’s in the preoperative. The prolongation of right PNTML of the nighty-five percent severe POP with recurrent SUI extends 0.55 ms at least in the preoperative. But whether if it need to do preventive anti incontinence surgery at the same time to whose average prolongation of the right PNTML extending 0.55 ms at least compared with the health’s remains to be further research in the future.