Menopausal pelvic organ prolapse

　　1. Etiology

　　1. Pelvic organ prolapse is mainly caused by delivery injury. Severe birth injuries can lead to pelvic organ prolapse, which has already appeared symptoms after childbirth. Most pelvic organ prolapses are delayed, and the incidence and severity of symptoms increase with the increase of the years after menopause.

　　2. Since most women with pelvic organ prolapse have given birth, delivery injury is the anatomical basis for the occurrence of pelvic organ prolapse. Occasionally, women without a delivery history may experience uterine prolapse, which is related to the congenital maldevelopment of pelvic floor tissues. Regardless of whether the defect in pelvic floor support tissues is due to birth injury or congenital maldevelopment, the onset of symptoms of pelvic organ prolapse often occurs during the perimenopausal period, and the symptoms of pelvic organ prolapse after menopause are more severe. Therefore, estrogen plays an important role in regulating the tension of pelvic floor tissues.

　　2. Pathogenesis

　　1. Sufficient research and literature have proven that estrogen and progesterone receptors are present on the round ligament, main ligament, and sacral ligament of the uterus in its normal position. The vaginal fascia, anal muscle, and their fascia, which are in the normal position of the urinary bladder and rectum, also have estrogen and progesterone receptors. The decline in estrogen levels and their receptors after menopause plays an important role in the occurrence of pelvic organ prolapse. There is a wealth of research on the receptors of pelvic organ support tissues.

　　2. Through immunohistochemical staining research: regardless of age, ethnicity, parity, body mass index, and whether menopausal, the nuclei of smooth muscle in the uterine sacral ligament all exist estrogen and progesterone receptors, while collagen, vascular, or neuronal tissues in the uterine sacral ligament were not found to have estrogen and progesterone receptors. Therefore, the uterine sacral ligament is a target organ for estrogen and progesterone, and hormones play a role in pelvic support through this action.

　　3. Through immunocytochemical staining and image analysis, a quantitative method was used to study the estrogen and progesterone receptors (ER, PR, AR) in 55 cases of gynecological surgery patients, and it was found that ER was found in the interstitial cells of the levator ani muscle, and there were varying degrees of ER, PR, AR expression in the levator ani fascia, but no ER expression was found in the muscle fiber nuclei.

　　4. In the study of primate animal models, it was found that the para-vaginal attaching tissue is composed of the levator ani muscle and dense collagen and elastic fibers infiltrating the muscle fibers. The fibroblasts in the tissue all have estrogen and progesterone receptors and respond to hormones.

　　5. Lang Jinghe (2003) and others used immunohistochemical methods to semi-quantitatively determine the estrogen receptors in the cardinal ligament and sacral ligament of the uterus, and found that the serum estrogen levels and the ER values of the uterine ligaments in perimenopausal women with pelvic organ prolapse were significantly reduced, and this reduction was proportional to the extension of the menopausal years. Lang Jinghe's study further illustrates that the pelvic organ prolapse in perimenopausal and menopausal women is related to the decrease in estrogen and the decrease in ER in the pelvic floor supporting tissues.

　　6. The histological study of pelvic organ prolapse in postmenopausal women focuses on the changes in smooth muscle cells, fibroblasts, and collagen in the supporting tissues.

　　7. Through histological study of the collagen synthesis of fibroblasts in the vaginal fascia and the content of type I procollagen mRNAs, the study aimed to determine whether the extracellular matrix of patients with pelvic relaxation is dysfunctional. The results show that with age, the cellular composition of fascial tissue and the biosynthesis of fibroblast collagen both decrease. These two changes are related to age and hormone status, and are not related to uterine prolapse. The growth of fibroblasts and the synthesis of collagen in patients with uterine prolapse show the same or slight increase as the control group. Makinen's study indicates that it is not the decrease in the growth of fibroblasts and the synthesis of collagen that causes pelvic relaxation, but the increase in age and the decrease in estrogen that lead to the decrease in the cellular composition of the fascial tissue and the biosynthesis of fibroblast collagen.

　　8. The results of the study differ slightly from those of Makinen, which examined the extracellular matrix content of the vaginal fascia, cardinal ligament, sacral ligament, and round ligament in women with pelvic organ prolapse through histopathological examination, and compared them with women without prolapse. It was found that the key factor in the weakness of the supporting tissues in women with pelvic organ prolapse is the decrease in fibroblasts in the extracellular matrix and the increase in collagen content.

　　9. Measurement of uterosacral ligament recovery (UsR) through surface tension measurement technique. It was found that UsR in patients with symptomatic uterovaginal prolapse was significantly reduced (P=0.02). UsR is related to vaginal delivery (P=0.003), menopause (P=0.009), and age increase (P=0.005). It is believed that the uterosacral ligament in postmenopausal women becomes significantly thinner, containing fewer estrogen and progesterone receptors, leading to a decrease in UsR and tension, which promotes the symptoms of pelvic visceral prolapse.

　　Severe patients may have difficulty in defecation and urination. The long-term friction of the exposed cervix or vaginal wall with clothing and pants can lead to local ulcers, bleeding, and other conditions on the cervix or vaginal wall, and secondary infection may lead to purulent discharge. Patients with anterior vaginal wall prolapse may have urinary disorders such as incomplete urination, urinary retention, and urinary incontinence, and sometimes it is necessary to lift the anterior vaginal wall upwards to urinate. Posterior vaginal wall prolapse may be accompanied by difficulty in defecation. Severe bladder prolapse may be complicated with bilateral hydronephrosis, even renal insufficiency.

　　I. Clinical Staging of Pelvic Organ Prolapse

　　There are different methods for quantitative staging of pelvic organ prolapse. The most commonly used internationally is the quantitative system formulated by Baden in 1968. The opinions of the Research Cooperation Group of 'Two Diseases' held in Qingdao in 1981 are introduced in the current Chinese textbooks. Both methods stage the quantitative degrees of any bladder prolapse, rectal prolapse, intestinal prolapse, descent of the uterine or vaginal fornix, with the hymen as a reference point. Due to the lack of reproducibility and specificity of this measurement system, its terminology is not accurate enough in describing the position of tissue prolapse. In 1996, the International Continence Society (ICS) recommended the Pelvic Organ Prolapse Quantitative Staging Method (POP-Q). The following are the introductions of the three staging methods.

　　1. China Staging Method:Opinions of the Research Cooperation Group of 'Two Diseases' in some provinces, cities, and autonomous regions held in Qingdao in 1981: The degree of descent of the uterus during the examination when the patient is lying flat and straining downwards is used to divide the uterine prolapse into three degrees:

　　(1) I degree: Mild: The external os of the cervix is at a certain distance from the margin of the hymen

　　(2) II degree: Mild: The cervix prolapses out of the vaginal orifice, while the corpus uteri remains within the vagina; Severe: Part of the corpus uteri prolapses out of the vaginal orifice.

　　(3) III degree: The cervix and corpus uteri are completely prolapsed out of the vaginal orifice.

　　2. Baden Classification Method:

　　(1) 0 degree: No prolapse.

　　(2) I degree: The prolapsed tissue is located between the ischial spines and the hymen.

　　(3) II degree: The prolapsed tissue reaches the vaginal orifice.

　　(4) III degree: Part of the prolapsed tissue protrudes out of the vaginal orifice.

　　(5) IV degree: The prolapsed tissue completely protrudes out of the vaginal orifice.

　　3. The International Continence Society Pelvic Organ Prolapse Quantitative Staging Method (POP-Q):This method divides the vagina into 6 points and 3 diameters, and measures the relationship with the hymen in centimeters.

　　(1) Point Aa: Located at the midpoint of the anterior vaginal wall, 3cm away from the urethral orifice, corresponding to the urethral bladder fold, with a numerical range of -3 to +3.

　　(2) Point Ba: Located between the vaginal apex and the anterior fornix, where the vaginal reflection from the anterior fornix to the Aa point is the most prominent on the anterior vaginal wall, without prolapse, this point is located at -3.

　　(3) Point C: The farthest end of the cervix, or the vaginal apex after total hysterectomy.

　　(4) Point D: Located in the posterior fornix, corresponding to the attachment of the uterosacral ligament to the cervix; if the cervix has been removed, this point is omitted.

　　(5) Point Ap: Located at the midpoint of the posterior vaginal wall 3 cm away from the hymen, with a numerical range of -3 to +3.

　　(6) Point Bp: The farthest point along the axis of the posterior vaginal wall upwards, that is, the most prominent point of the vaginal reflection from the posterior fornix to the Ap point, without prolapse, the distance from the hymen is 3 cm.

　　Symptoms and signs of pelvic organ prolapse in menopausal women

　　9. Women with grade I prolapse generally have no discomfort and are often found during gynecological examinations. For pelvic organ prolapse of grade II or above, the symptoms and signs vary depending on the organ involved and the degree of prolapse. The common symptom is the descent of a 'mass' from the vaginal orifice after standing for a long time or after fatigue, which recedes spontaneously after lying down. As age increases, the prolapse symptoms gradually worsen, and the 'mass' cannot be retracted by hand. The exposed cervix and/or vaginal wall, which rub against clothing for a long time, may develop ulcers, accompanied by purulent discharge.

　　8. Uterine prolapse causes traction on the uterine ligaments, pelvic congestion, and patients may have varying degrees of sacral pain or a feeling of descent, which is more pronounced after standing for a long time or after fatigue. Symptoms are alleviated after lying down and resting.

　　7. Cystocele may cause difficulty in urination, urinary retention, and is prone to bladder inflammation. Patients may have symptoms such as frequent urination, urgency, and dysuria. Cystocele often accompanies urethral prolapse, excessive movement of the bladder neck, and often leads to stress urinary incontinence.

　　6. Severe rectal prolapse can cause a feeling of descent, lower back pain, difficulty defecating, constipation, and may also lead to stress urinary incontinence.

　　5. Intestinal prolapse, also known as rectouterine pouch hernia, often manifests as low back pain, pelvic pressure, and due to the gravitational pull on the mesentery inside the pouch, the sensation of descent worsens when standing for a long time. Due to the protrusion of a mass inside the vagina, there is often an uncomfortable sensation in the vagina, difficulty in sexual intercourse, and these symptoms worsen with vaginal dryness.

　　1. Pelvic organ prolapse during the menopausal period: Whether in developed or developing countries, the number of patients with pelvic organ prolapse (POP) in perimenopausal and menopausal women has increased significantly. The incidence rate varies due to different eras, regions, ethnicities, and statistical methods. According to Olsen (1997), in 1995, 20% of women over 50 with a history of childbirth in the United States underwent surgery due to pelvic floor relaxation.

　　In the surgical patients of Nnamdi Azikiwe University Teaching Hospital in Nigeria from January 1996 to December 1999, 159 were diagnosed with pelvic organ prolapse (POP), and the number of women over 40 years old was twice that of women under 40. The annual incidence of uterine prolapse and perineal prolapse in women over 40 was 3.75%, which was 1.7 times higher than the 2.2% in the under-40 group.

　　Blood routine, urine routine, vaginal secretion examination, hormone level detection:

　　8. There are already various imaging methods used to display pelvic anatomy, supportive tissue defects, and the relationship between adjacent organs. Since each method has certain limitations, there is no specific method to date. Generally, commonly used methods include ultrasound examination, magnetic resonance, CT, and X-ray examination.

　　7. Dietz's research shows that transvaginal ultrasound can quantitatively examine the prolapse of female pelvic organs, and its results have good correlation with the International Continence Society's quantitative staging method for prolapse. This method is suitable for objectively evaluating the effect of surgery. Zhang Yongxiu's research uses transvaginal B-ultrasound to dynamically observe the urethra, bladder, and bladder neck for anatomical changes caused by pelvic floor tissue defects, and determines the criteria and critical values for diagnosing female stress urinary incontinence. Ultrasound diagnosis provides an objective basis for the diagnosis of pelvic organ prolapse and the assessment before and after surgery. Due to its safety, low cost, and ease of popularization, it is the most suitable method.

　　6. Recently, many literature recommendations use magnetic resonance imaging (MRI) to assist in the diagnosis of POP. Different densities of soft tissues can be distinguished in MRI, which can clearly show the prolapse of pelvic organs and the pelvic floor structure under increased abdominal pressure. It can quantitatively measure the size of bladder prolapse, rectal prolapse, intestinal prolapse, uterine prolapse, and genital tract fissures, and can also be dynamically observed and measured. MRI can make an accurate diagnosis of the support defects of the pelvic floor structure and has changed the traditional diagnostic methods, which can be used to guide surgical methods. Kaufman believes that MRI has a broad prospect in the research of pelvic organ prolapse, but its high cost makes it difficult to popularize at present.

　　5. CT examination of the pelvis can show the length of the anal muscle, the transverse and longitudinal diameters of the anal muscle gap, the obturator internus and obturator externus muscle cores, and CT provides a non-invasive and objective examination method for detecting injuries to the pelvic diaphragm muscles and fascia.

　　4. Placing a metal chain in the urethra for X-ray urethral urethrography was once an important method for imaging examination of female stress urinary incontinence. Due to its invasiveness, it has gradually been replaced by other imaging methods. Kenton attempted to determine the position of pelvic organ prolapse through vaginal造影 during X-ray pelvic periscopic surgery, but the conclusion was negative because internal organs must have contrast agents for X-ray examination. Pelvic organ prolapse involves multiple organs, and there is currently no contrast agent that can simultaneously image the bladder, small intestine, and rectum. It seems that there is little prospect for its application in the diagnosis of pelvic organ prolapse (POP).

　　Perimenopausal pelvic organ prolapse can consume more foods rich in vitamins, inorganic salts, and fibers, and high-protein foods, preferably in soup form. Maintain smooth bowel movements. Enhance immunity. Avoid heavy physical labor and lifting heavy objects. Minimize long walks to avoid fatigue on the journey. Avoid slippery vegetables and aquatic products. This may lead to weakness of the spleen and stomach, causing the uterus to drop down and be difficult to recover.

　　First, treatment

　　1. Estrogen in postmenopausal women

　　The status of pelvic organ prolapse treatment during perimenopause and postmenopause is closely related to the decline in estrogen levels. Estrogen plays an important role in the treatment of pelvic organ prolapse.

　　(1) Prevention of the occurrence of symptoms of pelvic organ prolapse: Pelvic organ prolapse has been present as early as the later stages of pregnancy and postpartum, but most women have no symptoms. According to Sze (2002) statistics based on the International Continence Society standards, 46% (43/96) of primiparous women have pelvic organ prolapse at 36 weeks of pregnancy, 32% (13/41) after vaginal delivery, or 35% (9/26) in active cesarean section. However, most patients before menopause have no symptoms, which is related to the estrogen level in women of childbearing age. We often find POP during women's general health check-ups, but patients have no symptoms. In postmenopausal women using HRT, it is rare to have pelvic organ prolapse with symptoms. HRT can prevent the occurrence of symptoms, but the exact preventive effect is currently lacking reliable statistical data.

　　(2) Treatment and alleviation of symptoms of pelvic organ prolapse: For symptoms of pelvic organ prolapse that occur during perimenopause or postmenopause, if it is mild prolapse, symptoms can disappear or be alleviated with systemic or local estrogen use.

　　(3) Preoperative use creates good local conditions for pelvic organ prolapse: For moderate to severe pelvic organ prolapse, ulcers on the vaginal wall or cervical surface that have been long-term rubbed by clothing must be treated with estrogen to heal quickly. Preoperative use of estrogen is beneficial for the proliferation of vaginal epithelium, increases the thickness of the vaginal wall, the elasticity of connective tissue, the thickness and tension of the anal muscles and their fascia, and aids in identifying anatomic layers, reducing potential tissue damage during surgery. Local application of cod liver oil containing estrogen is better than estrogen tablets, because the vaginal wall secretions in the elderly are less, and it is difficult to dissolve dry tablets for absorption. Theofrastous believes that preoperative use of estrogen can reduce the time for indwelling catheter after pelvic organ prolapse correction surgery.

　　(4) Postoperative use helps in the healing of vaginal wounds: Continuing to use estrogen after surgery aids in wound healing, increases the resistance of the vaginal epithelium, reduces the possibility of postoperative infection. If there are no contraindications to systemic estrogen use after surgery, oral or topical application is preferable, and it can be used on the first day after surgery. Long-term use of estrogen is beneficial for consolidating the efficacy of surgery. Grody (1997) advocates that patients use estrogen for at least 6 to 8 weeks before surgery and ensure lifelong hormone replacement. Otherwise, pelvic organ prolapse repair surgery will be refused. If there are contraindications, a local ointment containing estrogen and broad-spectrum antibiotics can be used, preferably starting 5 days after surgery. Early vaginal medication may cause wound infection or injury.

　　2. Women during menopause

　　Non-surgical treatment for pelvic organ prolapse: Mild pelvic organ prolapse without symptoms generally does not require treatment. For mild pelvic organ prolapse with symptoms, and moderate to severe prolapse that cannot be treated surgically, conservative treatment can be adopted.

　　(1) Medication Therapy:

　　① Estrogen Therapy: For symptoms or exacerbation of pelvic organ prolapse after menopause, estrogen therapy is convenient to use and has certain therapeutic effects on alleviating symptoms and reducing the degree of prolapse. Estrogen therapy is reported more often for stress urinary incontinence caused by urethral bladder prolapse. In clinical use, some patients with uterine prolapse who use estrogen before surgery experience symptom disappearance, reducing from grade II prolapse to grade I prolapse. It is worth using for patients with poor overall condition who are not suitable for surgery, and it is best to use it locally in the vagina. For those with contraindications to estrogen, vaginal use of estrogen-free products can be considered, such as the ointment of Promestriene (Ginesta) (Germany MERCK), which contains diethyl estradiol ether.

　　② Traditional Chinese Medicine: For Qi deficiency, use modified Bu Zhong Yi Qi Soup; for kidney deficiency, use modified Da Bu Yuan Jian Decoction. Xu Wei reported that using the outer husk of an immature walnut can be decocted into a bath for the treatment of grade I uterine prolapse, and its efficacy still needs to be verified by a large number of clinical trials.

　　(2) Physical Therapy: The Kegel method (1948) is still in use: Start by sitting in the bathroom, trying to stop urination during urination, start by relaxing, then squeeze the buttocks together until urine can be stopped, find the anal muscle, if you insert your finger into the vagina, you can feel the anal muscle being compressed. There are three different exercise methods:

　　① Rapid Compression Method: Compress and relax as quickly as possible.

　　② Continuous Compression Method: Compress with force for 3-5 seconds, then relax, and repeat.

　　(3) Gradual Compression Method: First, gently compress all the pelvic floor muscles, then gradually strengthen to the strongest possible extent, count to 5, relax, and repeat. Start with 3-4 exercises per day, each exercise 10 times, and increase 5 times per exercise every week, i.e., 10-20-25...times per exercise. The ideal exercise is 90-100 times per day. When performing pelvic floor exercises, it is necessary to relax the abdomen and breathe normally.

　　(4) Application of Vaginal Support Devices: The vaginal support devices used for treating uterine and vaginal prolapse are called pessaries. Modern pessary varieties include ring-shaped, spherical,喇叭花-shaped, double-disc type, etc. Liao Gengxin et al. reported that the use of a new double-disc pessary for the treatment of 120 cases of uterine prolapse achieved a total effective rate of 99.6%, with cure rates of 47.4% and 19.7% for grades I and II, respectively; significant efficacy rates of 52.6% and 75.0%. It is suitable for patients with mild prolapse who believe that the prolapse symptoms are not severe enough to require surgery, as well as for patients with severe complications who are not suitable for surgery, those who have undergone prolapse correction surgery but failed or recurred, and those who have no confidence in undergoing further surgery.

　　(5) Acupuncture Therapy: Acupuncture therapy can increase the tension of the pelvic floor tissues, and has certain therapeutic effects on alleviating symptoms and reducing the degree of prolapse. Basic acupoints: uterus, Stomach (ST) 36, if there is spleen deficiency, add Baihui (GV 20), Qihai (CV 6), Sanyinjiao (SP 6), Weidao (GB 34); for kidney deficiency, match Guanyuan (CV 4), Zhaohai (KID 6), Dahai (BL 52), acupuncture therapy is often combined with Chinese medicine for better efficacy. It is reported that its short-term effective rate (3 months) is about 96%.

　　3. Surgical treatment for pelvic organ prolapse in postmenopausal women

　　The surgical treatment for pelvic organ prolapse in postmenopausal women is different from that in premenopausal women in that reproductive capacity can be preserved, and there is no need to preserve sexual function in older women, so the uterus can be removed, and vaginal occlusion surgery can be performed. The latest surgical classification of TELINDE gynecology surgery, categorizes the surgery for pelvic organ prolapse according to the anatomical defect of the pelvic diaphragm.

　　(1) Repair of anterior vaginal wall prolapse - the repair of anterior vaginal wall prolapse is the most technically challenging. Considering that 15% to 20% of patients may develop urinary incontinence after vaginal anterior wall repair, and 15% of patients may have persistent or recurrent cystocele, we must assess two important factors before deciding on the surgical method.

　　(2) Middle pelvic diaphragm defect - enterocele and severe vaginal prolapse: Uterine prolapse in the postmenopausal period, with vaginal prolapse following the宫颈 prolapse out of the vaginal orifice, which can be enterocele or rectocele. It is necessary to fully understand whether there is enterocele before the operation. When correcting uterine prolapse, the correction surgery for enterocele should be performed at the same time. The vaginal apex must be fixed on the round ligament and sacroiliac ligament to prevent vaginal prolapse and prolapse after total hysterectomy. Vaginal prolapse and vaginal prolapse after total hysterectomy are often due to the weakness of the cardinal ligament and sacroiliac ligament, which are not enough to support the vaginal apex upwards. Vaginal or abdominal sacrotuberous ligament fixation is a surgical method that is effective in reconstructing the vaginal horizontal axis and restoring the vaginal position in the central sacrum.

　　(3) Posterior pelvic diaphragm defect - rectocele, perineal body tissue defect: The prolapsed posterior vaginal wall visible at the vaginal orifice is called rectocele. If the posterior vaginal wall prolapses out of the vaginal orifice even completely prolapses outside the vagina, it is called rectal prolapse. It often coexists with old perineal body lacerations. If accompanied by constipation or fecal incontinence, surgery is required. Vaginal posterior wall repair surgery and perineal laceration repair surgery have become familiar to obstetricians and gynecologists. What needs to be emphasized here is:

　　① When repairing the posterior vaginal wall, it is correct to find the levator ani and reconstruct the rectovaginal septum.

　　② Reconstruct the perineal body so that the upper two-thirds of the vaginal axis is in a horizontal position when standing, and the lower one-third points forward and downward, forming a 120° angle between the two segments.

　　(4) Conjoined pelvic diaphragm defect - uterine prolapse, enterocele, cystocele, rectocele: Severe uterine prolapse often accompanied by enterocele, cystocele, and rectocele, total vaginal hysterectomy with vaginal anterior and posterior wall resection is the most appropriate, and also a surgical method familiar to Chinese obstetricians and gynecologists. Before the operation, it should be routinely assessed whether there is any latent urinary incontinence. When the operation begins, a section diagnosis should be made first, taking endometrial tissue for frozen sectioning. During the operation, after the uterus is removed, measures should be taken to prevent the occurrence of enterocele. Before closing the peritoneum, the fingers should be inserted into the posterior mobile peritoneum of Douglas' pouch, to understand whether there is any redundant peritoneum that should be resected. If there is, it should be resected. When closing the abdominal cavity, the sutures should pass through the round ligaments and sacroiliac ligaments on both sides. If the sacroiliac ligament is hard, shortening the sacroiliac ligament helps to support the vaginal fornix. When the vagina is sutured, attention should be paid to suture the uterosacral ligament at the top of the vagina. If the vagina is too wide, a wedge-shaped resection of the posterior part of the vaginal apex should be performed.

　　(5) Application of Artificially Synthetic Materials in POP Surgery: All these surgeries pose fundamental issues for elderly women: all repair surgeries leave at least a part on the damaged, weak, and elastic fascia and tendons of the pelvic floor, thus making postoperative recurrence more likely. Secondly, the vaginal fixation surgery, whether fixed on the round ligament or the sacrotuberous ligament, ignores the loose and weak anterior vaginal wall itself. Thirdly, various suspension surgeries cannot solve the problem of bladder prolapse. Olsen et al. found through epidemiological studies that the recurrence rate of patients with vaginal vault prolapse after abdominal and vaginal repair surgeries is as high as 29.2%, and some even undergo repeated surgeries 3 to 4 times. Since 1986, artificial synthetic materials have gradually been used in POP repair surgeries, initially used for urethral suspension surgery for SUI, and recently used for the fixation and repair of vaginal vault prolapse and vaginal anterior and posterior wall prolapse. The general material is monofilament polypropylene mesh, with the following advantages: good tissue compatibility, causing no tissue reaction after implantation and being less likely to be rejected; strong tensile strength, non-absorbable, with certain extensibility and toughness; a certain size of mesh holes that can accommodate macrophages, allowing tissues to grow rapidly and reduce the incidence of infection; providing support for permanent pelvic floor support; light, soft, and compliant, not retaining bacteria. Currently, materials used in clinical applications include polypropylene mesh straps and polypropylene mesh patches.

　　II. Prognosis

　　With active treatment, the prognosis is good.