Conservative surgical treatment in cervical dysplastic lesions associated with cystorectocele

Journal of Mind and Medical Sciences Volume 6 | Issue 2 Article 22 2019 Conservative surgical treatment in cervical dysplastic lesions associated with cystorectocele Bogdan Marian Puca Anca D. Braila Cosmin V. Obleaga Mihai Braila Hany Saad See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Obstetrics and Gynecology Commons, Surgery Commons, and the Urology Commons Recommended Citation Puca, Bogdan Marian; Braila, Anca D.; Obleaga, Cosmin V.; Braila, Mihai; Saad, Hany; Lungulescu, Cristian; and Deca, Mihai (2019) "Conservative surgical treatment in cervical dysplastic lesions associated with cystorectocele," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 2 , Article 22. DOI: 10.22543/7674.62.P340345 Available at: https://scholar.valpo.edu/jmms/vol6/iss2/22 This Research Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at . Conservative surgical treatment in cervical dysplastic lesions associated with cystorectocele Authors Bogdan Marian Puca, Anca D. Braila, Cosmin V. Obleaga, Mihai Braila, Hany Saad, Cristian Lungulescu, and Mihai Deca This research article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol6/iss2/22 https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ ISSN: 2392-7674 J Mind Med Sci. 2019; 6(2): 340-345 doi: 10.22543/7674.62.P340345 Received for publication: March 18, 2019 Accepted: July 11, 2019 Research article Conservative surgical treatment in cervical dysplastic lesions associated with cystorectocele Bogdan Marian Puca1, Anca Daniela Braila2, Cosmin Vasile Obleaga1, Mihai Braila2*, Hany Saad3, Cristian Lungulescu4, Mihai Deca5 Craiova University of Medicine and Pharmacy, 1Department of General Surgery, 2Department of Obstetrics and Gynecology, 3Craiova University of Medicine and Pharmacy, 4Department of Oncology, 5Department of Urology, Craiova, Romania Abstract The treatment of cervical intraepithelial neoplasia aims at removing the squamocolumnar junction area, including abnormal tissues, up to the healthy tissue. Old postpartum perineal tears associated with cystorectocele, hypertrophic cervical elongation, and first and second degree uterine prolapse are pelvic static disorders. Particular aspects of pelvic-genital static disorder are related to the vulnerability of the pelvic-perineal floor during birth. On the occasion of birth, especially when there are different forms of dystocia during labor, the degradation of soft pelvic, genital, and vaginal-perineal tissues can occur. The objective of this study was to re-evaluate the conservative treatment of cervical dysplasia, depending on the degree of cervical lesions, the surface extension, the age of the patients, and the pathology associated with cervical lesions – colpocele, cystorectocele, and urinary incontinence in the old postpartum perineal tears. In order to solve the three types of concomitant lesions, we used the Manchester operation: the anterior colporrhaphy with the recalibration of the urethra and the suspension of the cystocele, the minimal colpectomy, the lesional cervical amputation with the anterior fixation of the parameters, and the posterior colpoperineorrhaphy with high myorrhaphy of the levator ani muscles. The decision on the management of cervical dysplasia has taken into account the degree of cervical lesions, the extension on the surface, the patients’ age and the pregnancy planning, and the pathology associated with cervical lesions. The Manchester operation is a conservative surgical procedure, effective in women under 45 years old, multiparous, with present genital activity, with dysplastic cervical lesions and cystorectocele. It also solves cystorectocele, cervical dysplasia, hypertrophic cervical elongation, and first and second degree uterine prolapse. Keywords  Highlights ✓ Triple surgery in Manchester is a surgical procedure indicated in patients under 45 years old, multiparous, with cervical and cystorectocele dysplasia. cervical dysplasia, cystocele, rectocele, conservative surgical treatment ✓ The management of cervical dysplasia depends on the degree and extent of the cervical lesions, the age of patients, the reproductive, menstrual and sexual functions, and the associated pathology. To cite this article: Puca BM, Braila AD, Obleaga CV, Braila M, Saad H, Lungulescu C, Deca M. Conservative surgical treatment in cervical dysplastic lesions associated with cystorectocele. J Mind Med Sci. 2019; 6(2): 340-345. DOI: 10.22543/7674.62.P340345 *Corresponding author: Mihai Brăila, Craiova University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, 2-4 Petru Rareş Street, 200349, Craiova, Romania E-mail: Bogdan Marian Puca et al. Introduction The treatment of cervical intraepithelial neoplasia aims at removing the squamocolumnar junction area, including abnormal tissues, up to healthy tissue. Cervical and vaginal cytological screening resulted in a significant reduction of the incidence and mortality rate by invasive cervical cancer (1). The notion of cervical dysplasia involves lesion of the squamous epithelium of the cervix, the precursor lesion of the invasive cancer, diagnosed through biopsy and histopathological examination. The severity of the intraepithelial lesion is classified as: mild dysplasia or CIN 1, moderate dysplasia or CIN 2, severe dysplasia or CIN 3, and carcinoma in situ (CIS). The neoplastic potential increases with the CIN (2) degree. Most cases of cervical neoplasia develop in the transformation area (TZ), adjacent to the squamocolumnar junction (SCJ) (3). Reserve cervical cells and immature metaplastic cells are vulnerable to the oncogenic effects of HPV and carcinogens (4). Old postpartum perineal tears associated with cystorectocele, hypertrophic cervical elongation, and first and second degree uterine prolapse are pelvic static disorders. These disorders are a consequence of a complex pathology of anatomical-functional and topographic modification of the position of the normal genital organs in the pelvis, bladder and rectal ampulla, vaginal walls, their tendency to descend outside the pelvic-abdominal compartment and to be expelled in the external environment as in total genital prolapse, with the rise of static pressure intra-abdominal effort, coughing, sneezing, grunting, respiratory dysfunction, and constipation. The substrate of these pelvic-genital disorders is dependent on several factors: the conformation of the pelvic-abdominal compartment in the human species related to the bipedal station, the intra-abdominal static pressure, the direction of the expulsion force in correlation with the bipedal station and the gravity, the counterpressure of the lower limbs, the m (...truncated)