Occurrence Of Pelvic Organ Prolapse Research Articles

Effects of pelvic-abdominal mechanics exercises during pregnancy on improving perinatal pelvic floor function in primiparous women

Objective: To explore the effects of pelvic-abdominal mechanics exercises during pregnancy on improving pelvic floor function in primiparous women during the perinatal period. Methods: A single-center prospective study selected 200 primipara of singleton pregnancies with prenatal care and delivery established at Shanghai Tongren hospital from June 2022 to June 2023 as the study subjects. Participants were divided into two groups: the exercise group (100 cases) and the control group (100 cases) by using a random number table method, five participants dropped out of the study due to reasons such as follow-up failure. Ultimately, the exercise group consisted of 97 cases, while the control group consisted of 98 cases. Participants who engaged in pelvic-abdominal mechanics exercises for at least 3 months, exercising once a week, were included in the exercise group. Those who did not engage in exercise were included in control group. Comparing the two groups in terms of pregnancy discomfort symptoms, delivery outcomes, postpartum pelvic floor electromyography results, postpartum quality of life, and pelvic floor disease incidence. The statistical methods utilized included independent t-test, Pearson chi-square test, Fisher's exact test, and Mann-Whitney U test. Results: In the late stage of pregnancy, the VAS score for low back pain was 5.05±1.22 in the exercise group and 5.47±1.55 in the control group, with a statistically significant difference (t=2.090, P<0.05). The PFDI-20 score was 23.33±8.41 in the exercise group and 25.76±8.34 in the control group, with a statistically significant difference (t=2.026, P<0.05). The PFIQ-7 score was 19.21±7.69 in the exercise group and 26.66±6.19 in the control group, with a statistically significant difference (t=6.851, P<0.05). There was no statistically significant difference in sleep quality and incidence of urinary incontinence between the two groups in late pregnancy (t=1.252, P=0.396, P>0.05). In terms of childbirth outcomes, the exercise group had a vaginal delivery rate of 81.44% (79 cases), while the control group had a rate of 64.28% (63 cases), with a statistically significant difference (χ2=9.022, P<0.05). The duration of the second stage of labor was (42.68±21.38) minutes in the exercise group and (50.54±21.33) minutes in the control group, with a statistically significant difference (t=2.178, P<0.05). At 42 days postpartum, the evaluation of pelvic floor function showed that the vaginal pressure in the exercise group was 62.19±10.04, while in the control group it was 52.68±15.55, with a statistically significant difference (t=-5.074, P<0.05). The MOS grading in the exercise group was 3.82±1.26, whereas in the control group it was 2.34±1.55, with a statistically significant difference (t=-7.355, P<0.05). In terms of the incidence of postpartum pelvic floor disorders, the occurrence of pelvic organ prolapse was 7.22% in the exercise group and 12.24% in the control group, with no statistically significant difference (χ2=1.402, P>0.05). The occurrence rate of stress urinary incontinence was 13.4% in the exercise group and 30.61% in the control group, with a statistically significant difference (P=0.015, P<0.05). Conclusion: Pelvic-abdominal mechanics exercises may have some advantages in reducing symptoms related to perinatal pelvic floor dysfunction, enhancing pelvic floor function, and preventing the occurrence of pelvic floor disease.

Effect of Vaginal Microecological Alterations on Female Pelvic Organ Prolapse

Introduction and HypothesisThe objective was to investigate the correlation between endogenous vaginal microecological alterations and female pelvic organ prolapse (POP).MethodsPatients who underwent vaginal hysterectomy were retrospectively analyzed as the POP group (n = 30) and the non-POP group (n = 30). The vaginal microbial metabolites and enzyme levels were tested using the dry chemoenzymatic method. The mRNA and protein expression were tested using real-time quantitative PCR and immunohistochemistry. SPSS version 25.0 and GraphPad Prism 8.0 were performed for statistical analysis.ResultsCompared with the non-POP group, the vaginal pH, H2O2 positivity and leukocyte esterase positivity were higher in patients with POP (all p < 0.05). Further analysis showed that patients with pelvic organ prolapse quantification (POP-Q) stage IV had higher rates of vaginal pH, H2O2 positivity and leukocyte esterase positivity than those with POP-Q stage III. Additionally, the mRNA expression of decorin (DCN), transforming growth factor beta 1 (TGF-β1), and matrix metalloproteinase-3 (MMP-3) in uterosacral ligament tissues were higher, whereas collagen I and III were lower. Similarly, the positive expression of MMP-3 in uterosacral ligament tissue was significantly upregulated in the POP group compared with the non-POP group (p = 0.035), whereas collagen I (p = 0.004) and collagen III (p = 0.019) in uterosacral ligament tissue were significantly downregulated in the POP group. Correlation analysis revealed that there was a significant correlation between vaginal microecology and collagen metabolism. In addition, MMP-3 correlated negatively with collagen I and collagen III (p = 0.002, r = −0.533; p = 0.002, r = −0.534 respectively), whereas collagen I correlated positively with collagen III (p = 0.001, r = 0.578).ConclusionsVaginal microecological dysbiosis affects the occurrence of female POP, which could be considered a novel therapeutic option.

FZD3 regulates the viability, apoptosis, and extracellular matrix degradation of vaginal wall fibroblasts in pelvic organ prolapse via the Wnt signaling pathway.

The occurrence of pelvic organ prolapse (POP) seriously affects women's quality of life. However, the pathogenesis of POP remains unclear. We aimed to clarify the role of Frizzled class receptor 3 (FZD3) in POP. FZD3 expression in the vaginal wall tissues was detected using immunohistochemistry, real-time polymerase chain reaction, and western blot analysis. Then, vaginal wall fibroblasts (VWFs) were isolated from patients with POP and non-POP, and were identified. Cell viability and apoptosis were evaluated using Cell Counting Kit-8 and flow cytometry, respectively. Extracellular matrix (ECM) degradation was assessed by western blot analysis. The results illustrated that FZD3 was downregulated in POP. VWFs from POP had lower cell viability, ECM degradation, and higher apoptosis. Knockdown of FZD3 inhibited cell viability, ECM degradation, and promoted apoptosis of VWFs, whereas overexpression of FZD3 had opposite results. Moreover, IWP-4 (Wingless-type [Wnt] pathway inhibitor) reversed the role of FZD3 overexpression on biological behaviors. Taken together, FZD3 facilitates VWFs viability, ECM degradation, and inhibits apoptosis via the Wnt pathway in POP. The findings provide a potential target for the treatment of POP.

Современный взгляд на проблему генитального пролапса через призму факторов риска.

Introduction. Pelvic organ prolapse (POP) is one of the varieties of pelvic floor hernias and has a significant impact on the quality of life of a modern woman. The prevalence of POP is quite high, and the peak values of its occurrence reach 5% in women aged 60 to 69 years. The current trend in the world towards an increase in the occurrence of POP is associated with an increase in the life expectancy of women, the participation of women in the production process, the presence of concomitant somatic pathology, the identification of risk factors in the detection of a small degree of prolapse allows identifying risk groups for rapid progression of POP and timely implementation of therapeutic measures. Aim. To identify new modern risk factors for POP. Materials and methods. The study is a cohort retrospective non-randomized. The main group consisted of 110 patients with grade II-IV POP according to the POP-Q classification. The control group consisted of 34 women without established gynecological diseases. Results. Women with PОР were significantly more likely to live in rural areas, had a higher average body weight than patients without gynecological pathology, they were in postmenopause for a longer time. Patients with POP were significantly more often observed for diseases of the chronic tonsillitis, the cardiovascular system, as well as for varicose veins of the lower extremities. The patients of the main group had more abdominal operations in the anamnesis and higher parity than in the control group. Conclusion. The risk factors for POP were the duration of postmenopause, high parity (natural childbirth) and overweight. The risk factors for PОР are diseases of the cardiovascular system, varicose veins of the lower extremities, chronic tonsillitis and surgical interventions on the abdominal organs.

OCCURRENCE OF PELVIC ORGAN PROLAPSE IN WOMEN: PREVALENCE, CONTRIBUTING FACTORS, AND IMPACT ON QUALITY OF LIFE

Pelvic Organ Prolapse (POP) stands as a prevalent health concern among women worldwide, characterized by the descent or herniation of pelvic organs, including the bladder, uterus, and rectum, into the vaginal canal. Objective: The primary aim of the study is to find the occurrence of pelvic organ prolapse in women and its prevalence, contributing factors, and impact on quality of life. This cross-sectional study was conducted in Catchment areas of Rural Health Centres Kangra and Kot Najibullah, District Haripur, Pakistan, from 1st November 2022 to 31st November 2023. Data was collected from 3284 women to find the pelvic organ prolapse in women and its prevalence, contributing factors, and impact on quality of life. The study comprised females diagnosed with various stages and types of POP, confirmed through clinical examinations, imaging studies, and documented medical history. Data was collected from 3284 female patients. The mean age of the patients was 54.01 ± 7.61 years. 60% of females are in the Pre-menopausal stage and 40% in the Post-menopausal stage. In managing Pelvic Organ Prolapse (POP), treatment modalities varied in utilization and exhibited distinct outcomes. Non-surgical interventions were employed in 30% of cases, resulting in a notable 70% relief in symptoms and a high patient satisfaction rate of 65%. It is concluded that this is a substantial problem for the women affected, yet the majority of affected women did not seek medical care. Pelvic organ prolapse is highly prevalent in rural Pakistan, impacts women’s everyday lives, and remains mainly untreated.

196 Serum Trace Minerals and Tumor Necrosis Factor Alpha Concentrations in Prolapsed and Non-Prolapsed Sows

Abstract Since 2014, pelvic organ prolapse (POP) has become a growing concern in the U.S. swine industry. Pelvic organ prolapse is one of the three leading causes of sow mortality today. While research has increased over the years investigating the cause and occurrence of POP, the reason for the increase in POP is not fully understood. Trace mineral status is one area of interest proposed to be associated with POP. We conducted a study to determine if there was a difference in serum trace minerals and tumor necrosis factor alpha (TNF-α) concentration between prolapsed and non-prolapsed sows. The study utilized 44 prolapsed sows and 44 non-prolapsed sows of the same parity, location, management, and stage of production. Blood was collected from the prolapsed and non-prolapsed sows upon discovery and processed at a local lab where serum was collected and stored until further analyses were performed. Serum samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS) for trace mineral content (Ca, Cu, Fe, K, Mg, Mn, Mo, P, Se, and Zn). Additionally, TNF-α concentration was determined from the serum using ELISA testing. Data were analyzed using the PROC GLIMMIX procedure in SAS. Prolapsed sows had decreased (P &amp;lt; 0.05) Fe (2.77 vs 3.76 ppm), Mo (9.22 vs 13.02 ppb), and Zn (1.07 vs 1.19 ppm) trace mineral concentration in the serum compared with the non-prolapsed sows. However, Mg was greater (P &amp;lt; 0.05) in prolapsed sows compared with non-prolapsed sows (23.24 vs 21.36 ppm). Selenium was marginally (P = 0.08) less in prolapsed sows compared with non-prolapsed sows (191 vs 206 ppb). There were no differences (P &amp;gt; 0.10) between prolapsed and non-prolapsed sows trace mineral concentrations for Ca (97.1 vs 99.1 ppm), Cu (2.07 vs 2.03 ppm), Mn (3.77 vs 3.72 ppb), P (52.5 vs 50.2 ppm), and K (264 vs 264 ppm). There was a difference (P &amp;lt; 0.05) in TNF-α concentration between the prolapsed and non-prolapsed sows (233.1 vs 178.9 pg/mL). This study suggests that there is a decreased concentration of various serum trace minerals found in prolapsed sows compared with non-prolapsed sows and an increased TNF-α response in prolapsed sows.

Identification of potential molecular mechanisms and therapeutic targets for recurrent pelvic organ prolapse

BackgroundThe pathogenesis of recurrent pelvic organ prolapse (POP) is currently unclear. Therefore, developing targeted preventive measures is difficult. This study identified potential key pathways, crucial genes, comorbidities, and therapeutic targets associated with the occurrence and development of recurrent POP. MethodsThe original microarray data GSE28660, GSE53868, and GSE12852 were downloaded from the GEO database. Identification and validation of differentially expressed genes (DEGs) and hub genes associated with recurrent POP were performed using R software and cytoHubba of Cytoscape. Protein–protein interaction (PPI) networks were constructed using the STRING tool and visualized using Cytoscape. Gene ontology (GO) and Kyoto Encyclopedia of Gene and Genome (KEGG) enrichment analyses were effectively performed using DAVID platforms. In addition, the NetworkAnalyst platform was used to explore and visualize the miRNA–hub gene network, TF–hub gene network, hub gene–disease network, and hub gene–drug/chemical network. ResultsA total of 110 DEGs and 6 hub genes (ADIPOQ, IL6, PPARG, CEBPA, LPL, and LIPE) were identified in this study. These genes were primarily enriched in the PPAR, AMPK, and adipocytokine, non-alcoholic fatty liver disease, and signaling pathways related to glycerol metabolism. Moreover, 96 miRNAs and 97 TFs were identified to as being associated with recurrent POP. These genes were closely linked to adipocyte metabolism and distribution, energy metabolism, and the longevity regulatory pathway. In addition, 192 diseases or chronic complications were potentially related to the recurrence of POP, including diabetes, hypertension, obesity, inflammatory diseases, and chronic obstructive pulmonary disease. Furthermore, 954 drugs or compounds were shown to have therapeutic potential for recurrent POP, and the most critical target drugs were dexamethasone, bisphenol A, efavirenz, 1-methyl-3-isobutylxanthine, and estradiol. ConclusionsThe results of this study revealed that ADIPOQ, IL6, PPARG, CEBPA, LPL, and LIPE as potential hub genes associated with recurrent POP, and these hub genes may aid in the understanding of the mechanism underlying POP recurrence and the development of potential molecular drugs.

Construction of a focal adhesion signaling pathway-related ceRNA network in pelvic organ prolapse by transcriptome analysis.

Objective: Pelvic organ prolapse (POP) affects a large proportion of adult women, but the pathogenesis of POP remains unclear. The increase in global population aging will impose a substantial medical burden. Herein, we aimed to explore the related RNAs regulating the occurrence of POP and provide potential therapeutic targets. Method: Tissue biopsies were collected from the anterior vaginal wall of six women with POP and six matched subjects without POP. The profiles of mRNAs, circRNAs, lncRNAs, and miRNAs were obtained by whole transcriptome RNA sequencing. Result: The findings revealed that 71 circRNAs, 76 known lncRNAs, 84 miRNAs, and 931 mRNAs were significantly altered (p < 0.05 and |log2FC| > 1). GO and KEGG enrichment analyses indicated that the differentially expressed genes (DEGs) were mainly enriched in the focal adhesion signaling pathway. FLT, ITGA9, VEGFD, PPP1R12B, and ROCK2 were identified as focal adhesion signaling pathway-related hub genes by protein–protein interaction network analysis. Based on the relationships between the DEGs and miRNA, lncRNA and circRNA targets, we constructed a focal adhesion signaling pathway-related ceRNA network. The ceRNA network includes hsa_circ_0002190/hsa_circ_0046843/lnc-CARMN -miR-23a-3p - ROCK2 and hsa_circ_0001326/hsa_circ_0007733/lnc-AC107959/lnc-TPM1-AS - miR-205-5p - ROCK2/PPP1R12B/VEGFD. Moreover, abnormalities in the cytoskeleton in fibroblasts from individuals with POP were observed. Conclusion: In this study, a focal adhesion signaling pathway-related ceRNA network was constructed, and this network may serve as a target for finding suitable drugs for the treatment of POP.

Do hiatal expansion and levator avulsion have a role in causation of pelvic organ prolapse?

AimTo examine whether hiatal expansion and levator avulsion have a role in the causation of pelvic organ prolapse (POP). MethodsData from studies which showed a strong association of hiatal expansion and levator avulsion were analysed for causation against an alternative view, POPcausation by ligament/connective tissue damage. ResultsSome studies potentially fitted the “Regularity Theory of Causality”; i.e., an apparent cause, occurred with such regularity as to be considered a cause. However, these studies failed the logical requirement of “unconditional”: all levator avulsions were to be followed directly by occurrence of POP, if the association were to be considered valid.Two studies which placed a large mesh behind the rectum and around puborectalis muscle greatly diminished levator expansion, but POP recurred in 78% of the women by 12 months. These results invalidated hypotheses of cause (levator expansion) and effect (prolapse). ConclusionsLevator avulsion/hiatal expansion co-occurs with POP. The cause for both is likely inability of the birth canal to plasticize” sufficiently to prevent simultaneous damage to the hiatal muscles and surrounding fascias and ligaments, which explains the co-occurrence. Greater than 90% cure of POP by site-specific repair of up to 4 pelvic ligaments supported the alternative hypothesis of simultaneous damage to pelvic ligaments to cause prolapse.

Effect of Nrf2 on Phenotype Changes of Macrophages in the Anterior Vaginal Wall of Women With Pelvic Organ Prolapse.

The aim of this study was to observe the effect of nuclear factor-erythroid 2-related factor 2 (Nrf2) on the phenotype changes of macrophages in the anterior vaginal wall of patients with pelvic organ prolapse (POP). The tissues of the anterior vaginal wall of the control group (n = 30) and POP groups (n = 60) were collected during operation. The expressions of Nrf2, iNOS (representative factor of M1 macrophages), and CD206 (representative factor of M2 macrophages) were determined by immunohistochemical staining and Western blot. Morphological changes and collagen distribution of the anterior vaginal wall were observed by hematoxylin-eosin staining and Masson trichrome staining. Compared with the control group, the expression levels of Nrf2 and CD206 protein in the anterior vaginal wall tissues of the POP groups were significantly decreased ( P < 0.05), and were negatively proportional to the degree of prolapse ( P < 0.05). The expression of iNOS was significantly increased and was directly proportional to the degree of prolapse ( P < 0.05). Hematoxylin-eosin staining and Masson trichrome staining showed that the collagen fibers are more sparsely arranged and disordered in the POP group than the control. In patients with POP, the expression of antioxidant factor Nrf2 is reduced in the vaginal anterior wall tissues and the antioxidant capacity is weakened, leading to the blocked polarization of macrophages and the accumulation of a large number of M1 macrophages in the tissue, affecting the occurrence and development of POP.

253 Determining the Relationship Between Different Risk Factors with Pelvic Organ Prolapse Incidence in Sows

Abstract Our objective was to evaluate the relationship of different putative factors with the occurrence of pelvic organ prolapse (POP) in sows. Data from 1,028 sows (PIC Landrace or PIC Camborough, Hendersonville TN) was collected at the final third of gestation, pre-farrowing, at farrowing, and post-farrowing from July to September 2021 in 2 sow farms located in South of Brazil. The annualized prolapse incidence from the 2 farms in 2021 was 2.22 and 3.63%. Whole-herd information and individual sow measurements were collected, including prolapse incidence, farrowing assistance, performance records, tail length, body condition score measured by caliper, perineal score (PS), fecal score (FS), oxytocin use. A logistic regression model using PROC LOGISTIC in SAS (Cary, NC) was utilized to assess risk factors associated with POP incidence rate, with sow as the experimental unit. Sows with PS3 and PS2 had greater (P &amp;lt; 0.001) POP incidence compared with sows with PS1 (38.46, 9.41, and 0.96%, respectively). Thin sows had greater (P &amp;lt; 0.001) POP incidence compared with ideal and fat sows combined (5.8 and 1.76%, respectively). Thin sows with FS1 (dry feces) had greater (P = 0.04) POP incidence compared with thin sows with FS2 and FS3 (normal feces; 8.09% and 1.81%, respectively), but no evidence for differences were observed for fat and ideal sows. Sows receiving farrowing assistance had higher (P &amp;lt;0.001) POP incidence compared with sows that were not sleeved (13.16 and 2.41%, respectively). Sows with tail length &amp;lt;13cm had greater (P = 0.01) POP incidence compared with sows with tail length &amp;gt;13cm (5.18 and 2.25%, respectively). There was also no evidence for an association between use of oxytocin (P = 0.38), total pigs born (P = 0.38), or total litter weight (P = 0.53) and POP incidence. In summary, PS, body condition, FS, farrowing assistance, and tail length appeared to be contributing factors associated with POP incidence in this system.

The Influence of Obstetric Factors on the Occurrence of Pelvic Floor Dysfunction in Women in the Early Postpartum Period.

BackgroundThis study aimed to analyze the effect of obstetric factors on the development of pelvic floor dysfunction (PFD) in women in the early postpartum period.MethodsClinical data of 300 women who were reviewed in our outpatient clinic from July 2016 to December 2019 in the postpartum period were retrospectively analyzed. The occurrence of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) was assessed using the Pelvic Organ Prolapse Quantification System and International Consultation on Incontinence Questionnaire Short Form. Factors affecting the occurrence of PFD in women in the early postpartum period were analyzed using univariate and multifactorial logistic regression models.ResultsA total of 46 cases of POP (15.33%) and 82 of SUI (27.33%) occurred in 300 women at 6–8 weeks after birth. Unconditional logistic regression confirmed that age ≥35 years, vaginal delivery, BMI before delivery ≥ 25 kg/m2, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia were risk factors influencing the occurrence of POP (OR > 1, P < 0.05), whereas age ≥ 35 years, vaginal delivery, perineal tear, protracted or prolonged second stage of labor, fetal macrosomia, and SUI during pregnancy were risk factors influencing the occurrence of SUI (OR> 1, P< 0.05).ConclusionObstetric factors such as age, mode of delivery, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia may increase the risk of developing PFD in women in the early postpartum period; hence, these risk factors should be correctly identified and promptly addressed to prevent the development of PFD.

\u201cLocus minoris resistentiae\u201d and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia

BackgroundConditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling.Case presentationThree cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general.ConclusionThe simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.

Transforming Growth Factor Beta 1 and p44/42 Expression in Cardinal Ligament Tissues of Patients with Pelvic Organ Prolapse.

BackgroundPelvic organ prolapse (POP) is a disease associated with collagen loss and decreased fibroblast proliferation. Transforming growth factor beta 1 (TGF-β1) controls collagen synthesis and degradation in pelvic connective tissue. Although the p44/42 MAPK pathway has been implicated in collagen production and extracellular matrix disorders, its expression in POP remains unknown. This study aimed to investigate TGF-β1 and p44/42 expression in cardinal ligament tissues in patients with POP.Material/MethodsCardinal ligament tissues were obtained from 30 patients with POP (POP group) and 30 patients with benign gynecological disorders who had undergone total hysterectomy (control group). The clinical characteristics of the 2 groups were summarized. Immunohistochemical staining and western blotting analysis were performed to measure the expression of TGF-β1, p44/42, phospho-p44/42, MMP9, TIMP1, caspase 3, collagen I, and collagen III in the cardinal ligament tissues.ResultsPatients with POP had significantly lower TGF-β1 and phospho-p44/42 levels than did control patients (P<0.05). The expression of TIMP1, collagen I, and collagen III was significantly lower, and the expression of MMP9 and caspase 3 was significantly higher in the POP group than in the control group (P<0.05). Moreover, the expression of phospho-p44/42 was positively correlated with the expression of TGF-β1, collagen I, and collagen III.ConclusionsThe expression levels of phospho-p44/42 and TGF-β1 were decreased in patients with POP and were positively correlated with collagen expression. Low levels of TGF-β1 and phospho-p44/42 expression in patients with POP may be associated with the occurrence of POP.

PIH23 Evaluation of Female Pelvic Floor Dysfunction in Hungarian Population

The aim of our study was to evaluate the prevalence of pelvic floor dysfunction and its effect on quality of life among Hungarian female population. Two hundred and three women above the age of 18 were included. We used two questionnaires, a self-constructed for demographic and previous obstetric history and the Australian Pelvic Floor Questionnaire (APFQ) to get information on pelvic floor function. There was a statistically significant association between the prevalence of urinary incontinence (56.2%) and increasing age (p≤ 0.001), body mass index (p≤ 0.001), number and mode of deliveries (p≤ 0.001; p≤ 0.001), previous episiotomy (p≤ 0.001) and pelvic organ prolapse surgery (p≤ 0.010). We found significant association between the occurrence of pelvic organ prolapse (27.1%) and increasing age (p≤0.002), number and mode of deliveries (p≤0.001; p≤ 0.001) and previous episiotomy (p≤0.001). A statistically significant association was found between the prevalence of anal incontinence (58.9%) and increasing BMI (p≤0.029), between faecal incontinence (16.8%) and previous obstetric perineal injury (p≤0.034). Sexual dysfunction (53,2 %) was significantly associated with respiratory disease and allergy (p≤0.048). We found significant association between the occurrence of multiple pelvic floor dysfunction and increasing age (p≤0.001), body mass index (p≤0.043), previous hysterectomy (p≤0.046) and pelvic organ prolapse surgery (p≤0.010). The appearance of anal incontinence (p<0.001), pelvic organ prolapse (p=0.036) and sexual dysfunction (p=0.043) was significantly more frequent in women with urinary incontinence. There was a significant difference between women having more severe pelvic floor dysfunction than milder complaints regarding quality of life (bladder p<0.000; bowel p<0.000; sexual dysfunction p<0.000 and pelvic organ prolapse p<0.000). Pelvic floor dysfunction was common in our study population, and had a great adverse effect on quality of life.

Expression Levels of Nerve Growth Factor and Its Receptors in Anterior Vaginal Wall in Postmenopausal Women With Pelvic Organ Prolapse.

To investigate the expression levels of nerve growth factor (NGF) and its receptors TrkA and p75NTR in the anterior vaginal wall of postmenopausal patients with pelvic organ prolapse (POP). The tissues of anterior vaginal wall of the patients (n = 31) with POP and patients (n = 16) with nonpelvic floor dysfunction were collected during the operation. The expressions of NGF, TrkA, and p75NTR were detected by real-time quantitative polymerase chain reaction, immunohistochemistry and Western blot. The expression levels of mRNA and protein of NGF and its receptors in vaginal anterior wall tissues of postmenopausal POP patients were significantly decrease compared with those of the control group. The ratio of p75NTR/TrkA expression in POP patients was significantly increase compared with that in the control group and was proportional to the degree of prolapse. The decreased expression of NGF and its receptors p75NTR and TrkA in vaginal anterior wall tissue of postmenopausal POP patients and the change of the ratio of 2 receptors may be related to the occurrence and development of POP.

Evaluation of the fibulin 5 gene polymorphism as a factor related to the occurrence of pelvic organ prolapse

OBJECTIVE Pelvic organ prolapse (POP) is a very frequent situation in our population that may lead to a significant decrease in patients' quality of life. Currently, we are looking for predictive factors for the development of POPs; thus, this study seeks to evaluate whether the Fibulin 5 polymorphism (FBLN5) is associated with the occurrence of POP. METHODS This is a cohort study with postmenopausal women who were divided into groups by POP stage: POP stages 0 and I (control group) and POP stages III and IV (case group). Subsequently, analyses of genetic polymorphisms of FBLN5 were performed using the Restriction Fragment Length Polymorphism (RFLP) technique. RESULTS A total of 292 women were included in the study. Pregnancy, parity and vaginal delivery in the patients, as well as in data described in the literature, were related to the occurrence of POP in the univariate analysis. However, after binary logistic regression, home birth and age remained independent risk factors for POP. We found no association between the FBLN5 polymorphism and the occurrence of POP (p = 0.371). CONCLUSION There was no association between the FBLN5 polymorphism and the occurrence of POP in Brazilian women.

Mechanical Stretching induces the apoptosis of parametrial ligament Fibroblasts via the Actin Cytoskeleton/Nr4a1 signalling pathway

The anatomical positions of pelvic floor organs are maintained mainly by ligaments and muscles. Long-term excessive mechanical tension stimulation of pelvic floor tissue beyond the endurance of ligaments or muscles will lead to the occurrence of pelvic organ prolapse (POP). In addition, cytoskeletal reconstitution is a key process by which cells respond to mechanical stimulation. The aim of the present study was to investigate the protective effect of actin cytoskeleton to resist mechanical stretching (MS)-induced apoptosis in parametrial ligament fibroblasts (PLFs) and the underlying mechanisms. MS provided by a four‑point bending device could significantly induce apoptosis of PLFs from non-POP patients, which exhibited an apoptosis rate close to that of PLFs from POP patients, and the apoptosis rate was higher following latrunculin A (Lat-A, a potent inhibitor of actin) treatment. In addition, Nr4a1 and Bax expression was increased while Bcl-2 and caspase-3 expression was clearly decreased after treatment with MS and Lat-A. However, the apoptosis induced by MS was reduced when the expression of Nr4a1 was downregulated by siRNA. These outcomes reveal a novel mechanism that links the actin cytoskeleton and apoptosis in PLFs by Nr4a1; this mechanism will provide insight into the clinical diagnosis and treatment of POP.

Identification of pelvic organ prolapse risk susceptibility gene SNP locus in Xinjiang women.

Susceptibility genes play an important role and have regional specificity in the occurrence of pelvic organ prolapse (POP). This study aims to identify POP susceptibility genes and their loci in ethnic minorities with different genetic backgrounds from Xinjiang in China, providing a theoretical basis for early POP diagnosis, treatment and prevention. Genomic DNA from peripheral blood of 196 patients was prepared; there were 88 POP patients and 108 non-pelvic floor dysfunction patients. We selected 16 different susceptibility gene single-nucleotide polymorphism (SNP) loci, which had been identified as associated with POP risk by researchers in other countries, and carried out genotyping through the Snapshot reaction. The allele and genotype frequencies, odds ratio (OR) and 95% confidence interval (CI) were analyzed using SPSS 17.0 software. The genotypic and allelic distributions demonstrated significant differences between the patients and the control subjects in the group of minority women, details are as follows: ESR1 rs17847075 AG: OR = 2.738, 95% CI = 1.067-7.025, P = 0.041; ESR1 rs2234693 TC: OR = 2.99, 95% CI = 1.163-7.684, P = 0.024; ZFAT rs1036819 CC: OR = 10.286, 95% CI = 1.158-91.386, P = 0.036; allele C: OR = 2.212, 95% CI = 1.146-4.269; P = 0.02; FBLN5 rs12589592 AA: OR = 0.111, 95% CI = 0.013-0.952, P = 0.029; allele A: OR = 0.482, 95% CI = 0.254-0.913, P = 0.028. ESR1 rs17847075 genotype AG in the dominant model (P = 0.008) or heterozygous model (P = 0.045), ESR1 rs2234693 genotype TC in the dominant model (P = 0.008) or heterozygous model (P = 0.028), and ZFAT rs1036819 genotype CC and allele C in the recessive model (P = 0.042) were significantly associated with POP risk in Xinjiang woman.

Assessment of Metalloproteinase Matrix 9 (MMP9) Gene Polymorphisms Risk Factors for Pelvic Organ Prolapse in the Brazilian Population.

To evaluate the C-1562T matrix metalloproteinase 9 (MMP9) gene polymorphisms as risk factors related to the occurrence of pelvic organ prolapse (POP) and to identify the clinical variables associated with the occurrence of the disease. Epidemiological studies of risk factors for POP do not explain why nulliparous women with no known risk factors also develop POP. Therefore, genetic factors may be involved. Cohort study with 86 women with symptomatic POP (cases), and 158 women without a prior or current diagnosis of this disorder (controls). The groups were analyzed for the presence of MMP9 gene polymorphisms. Genotyping was performed using polymerase chain reaction (PCR) with DNA obtained from a peripheral venous puncture of both groups. There were no differences between the cases and controls even when we grouped the mutant homozygous and heterozygous genotypes. The analysis of patients with a complete absence of POP versus patients with total POP also showed no statistically significant differences. Age and home birth were found to be independent risk factors for POP. There were no statistically significant differences in the C-1562T MMP9 polymorphisms between the cases and controls in Brazilian women.