Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
Int Urogynecol J. 2021 Aug;32(8):2111-2117. doi: 10.1007/s00192-021-04680-7. Epub 2021 Feb 19.
An enlarged genital hiatus (GH) is associated with the development of prolapse and may be associated with prolapse recurrence following surgery; however, there is insufficient evidence to support surgical reduction of the GH as prophylaxis against future prolapse. The objective of this review is (1) to review the association between GH size and pelvic organ prolapse and (2) to discuss the existing literature on surgical procedures that narrow the GH.
A literature search was performed in the PubMed search engine, using the keyword "genital hiatus." Articles were included if they addressed any of the following topics: (1) normative GH values; (2) associations between the GH and prolapse development or recurrence; (3) surgical alteration of the GH; (4) indications, risks or benefits of surgical alteration of the GH.
An enlarging GH has been observed prior to the development of prolapse. Multiple studies show that an enlarged pre- and/or postoperative GH is associated with an increased risk of recurrent prolapse following prolapse repair surgery. There are limited data on the specific risks of GH alteration related to bowel and sexual function.
GH size and prolapse appear to be strongly associated. Because GH size appears to be a risk factor for pelvic organ prolapse, the GH size should be carefully considered at the time of surgery. Surgeons should discuss with their patients the risks and potential benefits of additional procedures designed to reduce GH size.
增大的生殖道裂(GH)与脱垂的发展有关,并且可能与手术后脱垂复发有关;然而,没有足够的证据支持手术缩小 GH 以预防未来的脱垂。本综述的目的是(1)回顾 GH 大小与盆腔器官脱垂之间的关系,(2)讨论关于缩小 GH 的现有文献。
在 PubMed 搜索引擎中进行文献检索,使用关键字“genital hiatus”。如果文章涉及以下任何主题,则将其包括在内:(1)正常 GH 值;(2)GH 与脱垂发展或复发之间的关联;(3)GH 的手术改变;(4)GH 手术改变的适应证、风险或益处。
在脱垂发展之前已经观察到 GH 增大。多项研究表明,术前和/或术后 GH 增大与脱垂修复手术后脱垂复发的风险增加有关。关于 GH 改变与肠和性功能相关的具体风险的数据有限。
GH 大小和脱垂似乎密切相关。由于 GH 大小似乎是盆腔器官脱垂的一个危险因素,因此在手术时应仔细考虑 GH 大小。外科医生应与患者讨论旨在缩小 GH 大小的额外手术的风险和潜在益处。