Pelvic Organ Prolapse Patients Research Articles

Doppler ureteric jet in urogenital prolapse

This work was conducted to study the Doppler ureteric jets in the assessment of pelvic organ prolapse (POP) patients. Forty POP-Q stage ≧ III patients and 20 without POP were assessed with color Doppler ultrasonography. Among 40 POP, 28 had bladder outlet obstruction (BOO) and 4 had hydronephrosis. Comparing POP and controls, the difference in mean frequency, mean duration, and mean maximum velocity of ureteric jets was not statistically significant. The ureteric jets of POP with BOO are of longer duration and lower velocity. The frequency of ureteric jets was lower in POP with hydronephrosis. Plateau-type waveforms were much more common among POP associated with voiding and ureteric dysfunction. The longer duration and lower velocity of the ureteric jet are strongly correlated with prolapse-associated BOO. The plateau-type waveform and decrease in frequency of ureteric jets indicate possible hydronephrosis. Further investigation is needed to confirm the consistency of this study.

The effect of the modified pelvic reconstructive surgery for the pelvic organ prolapse

Objective To evaluate the effect of the modified pelvic reconstructive surgery for the pelvic organ prolapse. Methods 36 pelvic organ prolapse patients were divided into two groups, research group and control group. The research group received modified pelvic reconstructive surgery, while the control group was give traditional pelvic reconstructive surgery. The surgery duration, length of stay, blood loss during surgery between the two groups were compared. Results The research group had no patient who was recurrence, and no patient had complications.While the control group had 4 patients who was recurrence, and no patient had complications. The surgery duration,length of stay,blood loss during surgery of the control group was statistically more than the research group( all P ＜0. 05 ). Conclusion The modified pelvic reconstructive surgery for the pelvic organ prolapse could cure the pelvic organ prolapse effectively. And the modified pelvic reconstructive surgery was a better choice according to the traditional pelvic reconstructive surgery. Key words: The modified pelvic reconstructive surgery; Pelvic organ prolapse

Prospective multi-center study in "Xiehe" pelvic floor reconstruction surgery for severe pelvic organ prolapse

To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery. From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage III to IV from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. With a median follow-up of 14.0 months (6 - 28 months), twenty-three patients showed recurrent prolapse (8.3%, 23/277), and anatomical success (< stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6.9% (19/277). The postoperative de novo stress incontinence rate was 6.5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P < 0.01). And there was no significant difference in the average score of PISQ before and after the surgery (76.6 ± 15.4 versus 75.5 ± 14.5 versus 73.6 ± 12.6, P > 0.05), but the rate of de novo dyspareunia was 11% (9/80). "Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

Ultrasound imaging of the pelvic floor: where are we going?

We produced a non systematic review of ultrasound imaging of the pelvic floor in women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). We have searched the PubMed and Embase databases for the following PICO question: women; imaging; urinary incontinence, pelvic organ prolapse, pelvic floor, pelvic floor muscle, pelvic floor muscle training; physical examination, no imaging; diagnosis, prognosis, outcome. The production of a systematic review was deemed impossible based on the type and quality of the published evidence. Clinical research focused on the pathophysiology of the UI and POP looking relation between anatomic abnormalities, childbirth, the risk of UI or POP, the outcome of conservative treatment and reconstructive surgery. Published papers fall into the remits of diagnostic studies but often fail to comply with the recommendations of the STARD initiative. Most published evidence remains the product of a single institution effort and confirmatory studies are rarely found. Imaging studies in patients with UI did not provide evidence of any clinical benefit in the management of patients. In patients with POP, interesting correlations have been identified such as between childbirth, dimension of levator hiatus, avulsion of levator ani and risk of prolapse, but the non clinical benefit of pelvic floor imaging could still not be identified. Research on pelvic floor imaging requires a coordinated, international, multicentre effort to improve internal and external validity of imaging techniques, confirm observations published by single institutions and provide health technology assessment of imaging in the management of UI or POP patients.

Impact of colpocleisis on body image in women with severe pelvic organ prolapse

To investigate the impact of colpocleisis on body image in women with severe pelvic organ prolapse (POP). From Oct. 2005 to Feb. 2010, 60 POP patients with stage III and IV by POP quantitation system underwent total or partial colpocleisis. Patients received body image evaluation before and 1 year after operation. One year after operation, 52 (87%, 52/60) patients completed body image evaluation. Before and 1 year after operation, the ratio of answer "Not at all" of questions such as "Have you felt less physically attractive as a result of your vaginal prolapse?", "Have you been feeling less feminine as a result of your vaginal prolapse?", "Did you find it difficult to look at yourself naked?", "Have you been feeling less sexually attractive as a result of your vaginal prolapse?", "Have you felt dissatisfied with your body?" were 25% and 96% (P < 0.01), 21% and 96% (P < 0.01), 37% and 67% (P = 0.018), 29% and 96% (P < 0.01), 12% and 83% (P < 0.01), respectively, indicating significant improvement on body image after operation for patients treated by colpocleisis. Women underwent colpocleisis for severe POP could not decrease their body image as a result of the disability of vaginal intercourse.

2080 PELVIC RECONSTRUCTIVE SURGERY IN OCTOGENARIANS: ARE WE PUSHING THE LIMITS TOO FAR?

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20112080 PELVIC RECONSTRUCTIVE SURGERY IN OCTOGENARIANS: ARE WE PUSHING THE LIMITS TOO FAR? M. Raschid Hoda, Sigrid Wagner, and Paolo Fornara M. Raschid HodaM. Raschid Hoda Halle, Germany More articles by this author , Sigrid WagnerSigrid Wagner Halle, Germany More articles by this author , and Paolo FornaraPaolo Fornara Halle, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although the use of transobturator mesh implants for pelvic organ prolapse repair has been shown to be safe and effective, little data exist on their efficacy and appreciation in elderly women. This report describes our experience with pelvic reconstructive surgery in women with ages around or above 80 years. METHODS Prospective non-randomised study including 73 female patients aged >75 years with pelvic organ prolapse with or without stress urinary incontinence. Transvaginal anterior or posterior wall repair using transobturator mesh implants and concomitant transobturator sling procedure (25 Patients) were performed. Intra- and postoperative outcome data, POP-Q measurements, PAD-count, and quality of life measurements were recorded prospectively. Patients were followed for up to 12 months. RESULTS Mean age at surgery was 82.8±3.1 years. A total of 10 anterior repairs, 4 posterior repairs and 8 posterior and anterior repairs were performed using transobturator mesh implants. Concomitant synthetic mid-urethral transobturator sling procedure was performed in 18 women (82%). Mean operating time was 47.2±22.3 minutes, and the mean hospitalization period was 5.9±1.6 days. There were no systemic complications related to anaesthesia or surgery. Two patients (9.1%) required intraoperative bladder suturing due to iatrogenic bladder lesion. There were no rectal injuries, no bleeding necessitating transfusion, voiding dysfunction or erosions of synthetic implants. Pelvic floor testing at 24 months postoperatively showed 15% of the patients presenting with stage II vaginal wall prolapse. Further, quality of life parameters, as measured by SF-36 questionnaire, were improved compared to baseline values. CONCLUSIONS Results of our study demonstrate that pelvic reconstructive surgery using mesh implants is feasible for management of pelvic organ prolapse in patients around 80 years of age and results in improvement of quality of life. However, special caution should be paid to risks and benefits of such surgery in this patient population. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e832 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Raschid Hoda Halle, Germany More articles by this author Sigrid Wagner Halle, Germany More articles by this author Paolo Fornara Halle, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Expression of Bone Morphogenetic Protein-1 in vaginal tissue of women with severe pelvic organ prolapse

To analyze the differential gene and protein expression of Bone Morphogenetic Protein-1 in vaginal tissue of women with advanced pelvic organ prolapse and controls. We sampled the anterior vaginal wall of 39 premenopausal (23 patients and 16 controls), and 18 postmenopausal women (13 patients and 5 controls) during hysterectomy. Total mRNAs and proteins were quantified by real-time RT-PCR and immunoblotting. Bone Morphogenetic Protein-1 gene expression was decreased in pre- and postmenopausal pelvic organ prolapse patients compared with asymptomatic women (P = .01). The expression of 130 kDa, 92.5 kDa, and 82.5 kDa isoforms of Bone Morphogenetic Protein-1 were down-regulated in postmenopausal patients (P = .01), whereas the 130 kDa isoform expression was up-regulated in premenopausal patients (P = .009), when compared with respective controls. The Bone Morphogenetic Protein-1 expression in human vagina was altered in patients with severe pelvic organ prolapse and influenced by menopausal status. Dysregulation of Bone Morphogenetic Protein-1 may contribute for a deficient vaginal connective tissue and support.

Laparoscopic Hysteropexy in a Patient with Spina Bifida and Ventriculoperitoneal Shunt

Laparoscopic repair of pelvic organ prolapse in patients with ventriculoperitoneal shunts has not been previously described. The optimum management of patients with ventriculoperitoneal shunts undergoing laparoscopy is uncertain. We describe the case of a 21-year-old female patient with spina bifida and ventriculoperitoneal shunt who underwent laparoscopic hysteropexy for severe pelvic organ prolapse. The implications of performing laparoscopy on patients with ventriculoperitoneal shunts are reviewed along with strategies to reduce potential intraoperative complications.

Ring pessary for all pelvic organ prolapse

To evaluate the risk factors of unsuccessful fitting of ring pessary in pelvic organ prolapse (POP), continuation rate, and adverse events. The ring pessary was offered to 100 symptomatic POP patients. POP was staged according to Pelvic Organ Prolapse Quantification (POP-Q) system. A successful fitting was defined as when patients continued pessary use for more than 2 weeks. Adverse events were evaluated in patients who had a successful fitting. Most patients (71%) were in POP-Q stage III-IV and 77 patients were fitted at the initial visit. Successful fitting was reported in 62 patients (62%). However, 52 patients (52%) continued to use the pessary at 13 months median follow-up. The most common reason for discontinuation was frequent pessary expulsion. Short vaginal length ≤ 6 cm and wide introitus > 4 fingerbreadths were the significant risk factors for unsuccessful fitting. New onset of stress urinary incontinence (SUI) developed in 28.2% of patients. One third and 21% of patients had vaginal discharge and vaginal erosion, respectively. Only half of the patients could manage the pessary either by themselves or with their caregivers. The ring pessary fitting can be attempted in all POP cases irrespective of stage. Short vaginal length <6 cm and wide introitus >4 fingerbreadths were the risk factors for unsuccessful fitting. It has an acceptable continuation rate and manageable adverse events. The self-care of pessary is an important strategy to minimize adverse events.

Pelvic Organ Prolapse Management in Female Kidney Transplant Recipients

Pelvic organ prolapse in female postmenopausal kidney transplant recipients may be complicated by adverse events affecting graft function. We describe our experience with pelvic reconstructive surgery in renal transplant recipients. Pelvic reconstructive surgery was done in 16 female renal transplant recipients with pelvic organ prolapse with or without stress urinary incontinence. Intraoperative and postoperative data were recorded prospectively, including medical and surgical history, pelvic organ prolapse quantification measurement, 24-hour pad count, quality of life measurements and graft outcome. Patients were followed up to 12 months. Mean +/- SD age at surgery was 58.3 +/- 7.7 years (range 50 to 66). Mean time to renal transplantation was 54.2 +/- 15.1 months (range 38 to 123). A total of 12 anterior and 4 combined anterior/posterior colporrhaphies were done. A concomitant suburethral single incision transobturator sling procedure was performed in 8 women. We noted no bladder or rectal injury, bleeding necessitating transfusion or infection. Pelvic floor testing at 12-month followup showed stage I vaginal wall prolapse in only 4 patients (25%). No patient had evidence of de novo incontinence, synthetic sling infection, erosion or rejection. All women reported improved quality of life on the SF-36 questionnaire. Renal graft function remained stable in all patients. Pelvic reconstructive surgery is feasible for pelvic organ prolapse in patients with a kidney allograft on immunosuppression. However, concern about impaired graft function, infection and wound healing remains important.

1388 SEXUAL FUNCTION IN WOMEN BEFORE AND AFTER TENSION-FREE VAGINAL MESH PROCEDURE FOR PELVIC ORGAN PROLAPSE: A MULTICENTERE PROSPECTIVE STUDY IN JAPAN

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20101388 SEXUAL FUNCTION IN WOMEN BEFORE AND AFTER TENSION-FREE VAGINAL MESH PROCEDURE FOR PELVIC ORGAN PROLAPSE: A MULTICENTERE PROSPECTIVE STUDY IN JAPAN Miyabi Inoue, Toyohiko Watanabe, Tomoko Oishi, Ayano Ishii, Toyoko Yamato, Shinya Uehara, Hideo Ozawa, Teruhiko Yokoyama, and Hiromi Kumon Miyabi InoueMiyabi Inoue More articles by this author , Toyohiko WatanabeToyohiko Watanabe More articles by this author , Tomoko OishiTomoko Oishi More articles by this author , Ayano IshiiAyano Ishii More articles by this author , Toyoko YamatoToyoko Yamato More articles by this author , Shinya UeharaShinya Uehara More articles by this author , Hideo OzawaHideo Ozawa More articles by this author , Teruhiko YokoyamaTeruhiko Yokoyama More articles by this author , and Hiromi KumonHiromi Kumon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1038AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The polypropylene mesh is now available to augment surgery for pelvic organ prolapse (POP) in Japan. In this study we prospectively estimated sexual function before and after tension-free vaginal mesh (TVM) for surgical correction of pelvic organ prolapse. METHODS From March 2007 to March 2009, total 145 patients underwent TVM for surgical correction of POP. One hundred patients were sexually active before surgery and 27 patients were evaluated prospectively before and at 3, 6, and 12 months after surgery. Female sexual function was evaluated with the Female Sexual Function Index (FSFI) which was a 19-question, self-report measure, organized in a 6-domain structure, including desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. RESULTS Mean age at surgery was 65.8±7.8 years. Before surgery, sexual activity was significantly reduced in POP patients (FSFI 10.2±7.9) comparing to age-matched control group without POP (FSFI 20.1±9.9). Total FSFI scores improved significantly from 10.2±7.9 at baseline to 18.2±8.1 at 6months, 21.4±7.3 at 12 months after surgery. All domains except desire were improved significantly at 6 and 12 months after surgery. Frequency of sexual activity also increased 0.97 per month at baseline to 1.78 at 12 months after surgery. CONCLUSIONS Pelvic organ prolapse appears to have a significant negative impact on female sexual function. Tension-free vaginal mesh can contribute to an anatomical correction of POP, but also an improvement of sexual function. Okayama, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e536-e537 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miyabi Inoue More articles by this author Toyohiko Watanabe More articles by this author Tomoko Oishi More articles by this author Ayano Ishii More articles by this author Toyoko Yamato More articles by this author Shinya Uehara More articles by this author Hideo Ozawa More articles by this author Teruhiko Yokoyama More articles by this author Hiromi Kumon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical effects of anterior pelvic floor reconstruction(A-prolift)in the treatment of anterior pelvic organ prolapse

Objective To analyze the outcomes of 42 cases with anterior pelvic defects treated with'Gyne care Anterior Prolift System and to discuss the efficacy and safety of this system．Methods The complications of Aprolift operations,postoperative chnical efficacy and recovery,were Retrospectively analyzed and followed up the recunence rate and life satisfaction level among 42 pelvic organ prolapse patients who were staged as grade Ⅲ or Ⅳ according to POP-Q quantification from January 2008 to April 2009．Among these 42 cases,5 cases complicated with mild stress urinary incontinence,while 22 cases had different level of hypertension,cardiac disease,diabetes and respiratory diseases．Results A-prolift operations were carried out successfully in all 42 cases,with an average operation duration 50．6 min(40～70 min),average time for mesh placement was 17 min and average blood loss 200 ml (150～280 m1)．No injuries of bladder,blood vessels or nerve occurred．And also there was no ICU transference．The average hospitalization was 6．6 days(5～11 days),postoperation follow-up lasted about 1 month to 14 months,with an average of 8 months．Mesh erosion occurred in 1 case which quickly healed after local sterilization and removal of extra mesh．While increasing vaginal disacharge occurred in 2 cases and were relieved after cutting off the thread ends,which were assumed to be caused by malabsorption of thread．The outcomes proved to he satisfactory with 100％ of objective and subjective recovery rates,no complaint of dyspareunia and disappearance of incontinence symptoms in 5 cases who previously had SUI．Conclusion A-prolift is an effective,safe and pplicable treatment for anterior pelvic defects．as well as mild SUI．While long-term efficacy needs further study． Key words: Anterior pelvic organ prolapse; A-prolift

Reliable Identification of the Type III Collagen Gene Polymorphism rs1800255 with the Use of High Resolution Melting Analysis

Background: We have recently identified a homozygous nucleotide substitution in exon 30 of type III collagen (COL3A1 2209G>A, rs1800255) as a risk factor for the development of pelvic organ prolapse. This polymorphism is also associated with mitral valve prolapse. Patients could benefit from preventive actions when identified prior to clinical evidence of the disease. High resolution melting (HRM) analysis is a low-cost, high-throughput technique to identify DNA polymorphisms. The purpose of this study was to investigate whether HRM is an accurate method to detect the above mentioned polymorphism in DNA from blood samples Methods: A total of 36 randomly selected DNA samples from pelvic organ prolapse patients were analyzed in duplicate using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (PCR-RFLP) and sequence analysis. Using the latter as the gold standard, all samples were subjected to HRM analysis with the use of specific primers and an unlabelled probe. Results: Compared to sequence analysis, PCR-RFLP resulted in 2 incorrect diagnoses. High resolution melting analysis demonstrated unique melting profiles for wild-type, as well as heterozygous and homozygous polymorphisms, with 100% accuracy. Conclusion: High resolution melting is a fast, cost-effective, and sensitive screening method to detect the rs1800255 polymorphism.

Female urology: What method will you select?

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki

Incontinence and detrusor dysfunction associated with pelvic organ prolapse: clinical value of preoperative urodynamic evaluation

We examined how preoperative urodynamic findings are related to the urinary problems following surgical repair of pelvic organ prolapse (POP). The clinical records of 87 women who underwent surgery for POP were reviewed retrospectively. Preoperatively, cough stress test and urodynamic testing, including pressure-flow study, were performed with prolapse reduction. Postoperative evaluation included uroflowmetry, postvoid residuals, and symptom assessment using questionnaires. A cough stress test with simple filling was sufficient for diagnosis of occult stress urinary incontinence (SUI). The presence of detrusor overactivity was a good predictor of postoperative persistence of urgency and urge urinary incontinence. Postvoid residuals (PVR) largely increased immediately after surgery, but usually recovered within 1 month. Poor detrusor contractility was the best predictor of large PVR occurrence. Preoperative urodynamic evaluation of SUI and detrusor function was useful for predicting postoperative urinary conditions in POP patients. Its cost-effectiveness remains to be examined.

Expression and significance of elastin and fibulin-5 in anterior vaginal tissue of women with pelvic organ prolapse

To investigate the expression and significance of elastin and fibulin-5 in anterior vaginal tissue of women with pelvic organ prolapse (POP). Between November 2006 and June 2008, 68 patients with POP underwent surgical treatment in Shengjing Hospital of China Medical University were enrolled in this study, who were classified into 10 patients with grade I, 21 patients with grade II, 25 patients with grade III and 12 patients with grade IV in accordance with pelvic organ prolapse quantitation (POP-Q). Meanwhile, 18 cases with early cervical cancer at stage of I b were treated by total hysterectomy and bilateral salpingo-oophorectomy, their anterior vaginal tissues were selected as controls. Immunohistochemical staining was performed to detect the expression of elastin and fibulin-5. (1) Elastin and fibulin-5 were mainly expressed at extracellular matrix(ECM). (2) The positive rate of fibulin-5 expression in anterior vaginal wall were 5% (2/37) in grade III/IV and 26% (8/31) in grade I/IV POP patients, which reached statistical difference (P = 0.035). However, no statistical different expression was found between postmenopausal (13%, 8/60) and non-menopausal patients (2/8), vaginal delivery < or =2 (19%, 5/27) and >2 patients (12%, 5/41, P > 0.05). (3) The positive rate of elastin expression in anterior vaginal wall in POP group was 31% (21/68), which was significantly lower than 72% (13/18) of control group (P = 0.002). Among POP group, 19% (7/37) of elastin expression in grade III/IV POP was significantly lower than 45% (14/31) in grade I/II of POP patients. However, no statistical difference was found between postmenopausal (30%, 18/60) and non-menopausal patients (3/8), vaginal delivery < or =2 (26%, 7/27) and >2 patients(34%, 14/41, P > 0.05). (4) In POP group, both positive expression of fibulin-5 and elastin of anterior vaginal wall was in 6 cases, both negative expression of fibulin-5 and elastin was in 43 cases. It was illustrated that elastin and fibulin-5 had an positive relationship (P = 0.031). The decreased expression of elastin and fibulin-5 was correlated with degree of POP, which indicated that elastin and fibulin-5 may play a role in the pathogenesis of POP.

COL3A1 2209G&gt;A is a predictor of pelvic organ prolapse

A familial tendency has been demonstrated in the etiology of pelvic organ prolapse (POP), but the specific genetic defects have not been identified. Type III collagen is an important factor in the repair of connective tissue, and gene polymorphisms may impair the tensile strength. We hypothesized that polymorphisms in the alpha I chain of the type III collagen protein-encoding gene (COL3A1) pose women at risk for POP. In this case-control study, the prevalence of type III collagen polymorphisms was compared in women with and without signs and symptoms of POP. Two hundred and two POP patients and 102 normal parous controls were included. A homozygous single-nucleotide substitution in the coding region of type III collagen (COL3A1 2209G>A, rs1800255) was identified in 27 (13%) POP patients and three (3%) controls (odds ratio, 5.0; 95% confidence interval, 1.4-17.1). The probability of POP was higher in women with COL3A1 2209G>A. This polymorphism showed to be a relevant risk factor for POP.

The relation between genitourinary prolapse and joint hypermobility in Turkish women

In this cross-sectional study, we compared frequency of hypermobility syndrome in pelvic organ prolapse (POP) patients and normal healthy Turkish women. Sixty-five women who had diagnosed as POP and ward to surgery and 52 healthy women with similar age group were included into this study. It was found that subjects with POP had a significantly higher prevalence of joint hypermobility (53.8%) when compared with normal individuals (9.6%). No significant correlation was demonstrated between Beighton scores and incontinence, exercises pattern and hormone replacement therapy. We concluded that joint laxity is associated with POP but not with urinary incontinence in Turkish women.

Low copy number and high 4977 deletion of mitochondrial DNA in uterosacral ligaments are associated with pelvic organ prolapse progression

The pathophysiology of pelvic organ prolapse (POP) is related to aging in the pelvic organ support, and mitochondrial dysfunction is one of the major contributors to aging. Therefore, the objective of this study was to investigate the correlation between alternations of mitochondrial DNA and progression of POP. Polymerase chain reaction (PCR) was applied in the present study. Uterosacral ligaments (UL) were obtained from 45 POP patients and 38 myoma patients without POP. Chi-square test, Student's t-test, Mann-Whitney U test, and Spearman correlation analysis were applied in the comparison between POP and non-POP patients. The results revealed that significant depletion of mitochondrial DNA (mtDNA) and an increase in the incidence of 4977 deletion of mtDNA (mtDNA(4977)) in the UL tissue of POP patients. The alternations of mtDNA may play an important role in the molecular pathogenesis and process of POP formation.

Complications in Women Undergoing Burch Colposuspension Versus Autologous Rectus Fascial Sling for Stress Urinary Incontinence

We determined the clinicodemographic factors associated with complications of continence procedures, the impact of concomitant surgery on the complication rate and the relationship between the incidence of cystitis and the method of postoperative bladder drainage. We reviewed serious adverse events and adverse events in the Stress Incontinence Surgical Efficacy Trial, a randomized trial comparing Burch colposuspension to the autologous rectus fascial sling. Clinicodemographic variables were analyzed to determine those associated with adverse events using logistic regression analysis. Complications were stratified based on the presence or absence of concomitant surgery. Differences in complication rates (controlling for concomitant surgery) and cystitis rates (controlling for the bladder emptying method) were compared using Fisher's exact test. Blood loss (p = 0.0002) and operative time (p <0.0001) were significantly associated with an adverse event. Patients who underwent concomitant surgery had a significantly higher serious adverse event rate (14.2% vs 7.3%, p = 0.01) and adverse event rate (60.5% vs 48%, p <0.01) than patients who underwent continence surgery alone. Cystitis rates were higher in the sling vs the Burch group up to 6 weeks postoperatively regardless of concomitant surgery status (p <0.01). Intermittent self-catheterization increased the cystitis rate by 17% and 23% in the Burch and sling groups, respectively. Concomitant surgery at continence surgery increased the risk of complications. Sling surgery was associated with a higher risk of cystitis within the first 6 weeks postoperatively. Intermittent self-catheterization increased the risk of cystitis in each group. Complications were associated with surgical factors and not with patient related factors.