Biochemical properties of collagen metabolism in patients with recurrent genital prolapse.

Abstract

Purpose – to determine the features of collagen metabolism state in women with recurrent genital prolapse at the stage of scheduled surgery and in postoperative period using prolene implants. The level of hydroxyproline metabolites (HO) in 130 patients with recurrent genital prolapse (study group) who underwent prolene implant surgery to correct fascial defects and 30 patients without prolapse evidence (control group) were examined. State of collagen metabolism was assessed by plasma levels of free (FОP), peptideassociated (PAO) and protein associated oxyproline (PrAO) using P.N. Sharaeva’s method. The survey was carried out before surgery and in 6, 12 months after surgery. Phenotypic diagnosis of connective tissue dysplasia was made in points. For mathematical treatment of the results obtained the software package STATISTICA ® for Windows, Release 8.0 company StatSoft ® Inc., USA was used (2010). In the main group in 13 (10,3±1,6%) patients all parameters were above normal values, in 14 (10,8±3,8%) patients with normal values of PrAO and FOP there was a reduction of PAO. Reduction of both factions of oxyproline was determined in 7 (5,3±1,6%) patients. PrAO level in the study group was significantly higher than 11.24 (7,82-15,08) pmol/L, than in the control group – 9.54 (7,72-13,4) pmol/L (p<0,05). In 23 (17,7±3,1%) patients of the main group PAO decrease was observed against the background of increased FOP values. The number of patients with high levels of PrAO in different subgroups was different. However, no significant correlation changes of PrAO with the severity of CTD were defined. A significant difference of FOP indices in core group as compared with the control group 4,29 (5,43-9,76) pmol/l and 9,03 (4,95-9,92) pmol/L, respectively (p<0,05) was found. High median FOP 11.26 (9,48-25,05) level pmol/l was determined in patients with posthysterectomy prolapse. A reliable link of high levels of PAO with the severity of the CTD (p<0,05) was noted. In the study group there was an overall decline in median PAO 7,23 (6,01-11,3) pmol/l as compared to 9.31 (7,03-10,9) pmol/l PAO in the control group (p<0,05). In the study group six months after surgery PrAO level decreased by 26,8±1,8% (p<0,001) in relation to the initial values. After 12 months, PrAO level in the main group was rising gradually but was 19,7±1,2% lower as compared to the level before the surgery (p<0,05). The obtained results pointed to a high activity of collagen formation in the area of prolene implant placement and justified prolene implants use in patients with signs of destructive processes in the connective tissue. Determining PrAO level allowed to track the dynamics of activity of reparative processes after surgery and to establish 6 months’ period of limitation of physical exercises after surgery to create a full connective tissue scar around the implant.