scholarly journals Role of Fibroblasts and Myofibroblasts on the Pathogenesis and Treatment of Pelvic Organ Prolapse

Biomolecules ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 94
Author(s):  
Zeliha Guler ◽  
Jan Paul Roovers
Keyword(s):  
Pelvic Organ Prolapse ◽  
Connective Tissue ◽  
Pelvic Floor ◽  
Tissue Repair ◽  
Pelvic Organ ◽  
Connective Tissue Disorder ◽  
Collagen Metabolism ◽  
Tissue Quality ◽  
Pop Surgery

Pelvic organ prolapse (POP) is a multifactorial connective tissue disorder caused by damage to the supportive structures of the pelvic floor, leading to the descent of pelvic organs in the vagina. In women with POP, fibroblast function is disturbed or altered, which causes impaired collagen metabolism that affects the mechanical properties of the tissue. Ideal surgical repair, either native tissue repair or POP surgery using an implant, aims to create a functional pelvic floor that is load-bearing, activating fibroblasts to regulate collagen metabolism without creating fibrotic tissue. Fibroblast function plays a crucial role in the pathophysiology of POP by directly affecting the connective tissue quality. On the other hand, fibroblasts determine the success of the POP treatment, as the fibroblast-to-(myo)fibroblast transition is the key event during wound healing and tissue repair. In this review, we aim to resolve the question of “cause and result” for the fibroblasts in the development and treatment of POP. This review may contribute to preventing the development and progress of anatomical abnormalities involved in POP and to optimizing surgical outcomes.

Markers of connective tissue dysfunction in terms of surgical treatment for pelvic organ prolapse

2020 ◽  
Vol 19 (6) ◽  
pp. 90-95
Author(s):  
V.F. Bezhenar ◽  
◽  
E.K. Deriy ◽  
O.A. Ivanov ◽  
Sh.M. Azhimova ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Surgical Technique ◽  
Connective Tissue ◽  
Pelvic Floor ◽  
Individual Case ◽  
Pelvic Organ ◽  
Uterosacral Ligaments ◽  
Working Age ◽  
Patient’S History

Pelvic organ prolapse (POP) is a serious problem in urology and gynecology. Approximately 47% of women of working age suffer from POP. Due to the lack of uniform criteria for choosing an optimal surgical technique, POP relapses and stress urinary incontinence after pelvic floor surgeries are very common. The choice of surgical technique should be based on patient’s history as well as the results of instrumental, genetic, biochemical, morphological, and immunohistochemical examinations. This article covers the role of biochemical markers of POP analyzed in different tissues, such as blood, urine, cells of the vagina and uterosacral ligaments. It was found that different methods of POP markers identification can be used in each individual case. The decision on the tactics of surgical management of POP should be made after receiving the results of morphofunctional examination of the pelvic floor. Key words: connective tissue dysfunction, predictors, pelvic organ prolapse, gene expression

scholarly journals Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study

2021 ◽  
Author(s):  
Zhi-jing Sun ◽  
Tao Guo ◽  
Xiu-qi Wang ◽  
Jing-he Lang ◽  
Tao Xu ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Reconstructive Surgery ◽  
Tissue Repair ◽  
Pelvic Organ ◽  
Native Tissue Repair ◽  
Post Surgery ◽  
Management Of Complications ◽  
Surgery Delay

Abstract Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.

scholarly journals Role of Magnetic Resonance defecography in assessment of pelvic floor dysfunction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Moussa ◽  
Y I Abdelkhaleq ◽  
S M Botros ◽  
A A Montasser
Keyword(s):  
Pelvic Organ Prolapse ◽  
Physical Examination ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Magnetic Resonance Defecography ◽  
Facial Defect ◽  
Floor Failure ◽  
Muscle Tear

Abstract Purpose to assess the role of the role of MR defecography in assessment of pelvic floor failure . Methods and Material Thirty-six patients (twenty-seven female and nine male) with female and male patients, complaining of stress urinary incontinence, constipation, fecal incontinence or pelvic organ prolapse. Results MRI revealed 18 cystocele (50%), compared to physical examination 2 cases(5.6%),MRI revealed 28 rectocele ( 77.8%) compared to physical examination that showed 13 (36.1%) , MRI revealed 10 uterine descent (40.7%), compared to physical examination 6 (22.2%) I, MRI revealed 7 enterocele (19.4%) compared to physical examination that was negative. MRI revealed level I/II facial defect in and level III facial defect in, 19 cases of Intussusception (52.8%), urethral hypermobility in 14 (38.9%), sphincteric defect 7 (19.4%), levator angle weakness in 30 cases (83.3%), iliococcygeaus muscle tear in 5 cases (13.9%), puborectalis tear in 3 cases (8.3%),anorectal decent in 26 cases (72.2%), genital hiatus width in 23 (63.9%) Conclusion Dynamic MR imaging is a necessary tool in the diagnosis of multicompartment pelvic organ prolapse and it provides good concordance with clinical examination

Clinical and anamnestic and biological candidates for participation in the mechanisms of genital prolapse formation in women

2021 ◽  
Vol 20 (1) ◽  
pp. 82-88
Author(s):  
N. M. Milyaeva ◽  
V. V. Kovalev ◽  
E. A. Bortnik ◽  
E. V. Sivov ◽  
E. V. Kudryavtseva ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Scientific Research ◽  
Genital Prolapse ◽  
Pelvic Organ ◽  
Prediction And Prevention ◽  
Pubmed Database ◽  
Mechanisms Of Formation

Introduction. The article presents an overview of the results of modern evidence-based scientific research on the mechanisms of formation of genital prolapse as one of the fundamental causes of pelvic floor muscle insufficiency in women. A systematic analysis of the current literature data on the involvement of clinical, anamnestic and pathogenetic motives in the development of pelvic organ prolapse in women was carried out.Objective: to expand the understanding of the role of anamnestic and biological factors in the pathogenesis of genital prolapse in women.Material and method. The review includes the scale of publications of domestic and foreign authors included in the PubMed database on this topic with a search depth of 20 years. The criteria for inclusion of articles for the system analysis were articles corresponding to the topic chosen for the study of the problem of gynecology, namely, the pathogenesis of genital prolapse in women with a search depth of twenty years. The criteria for exclusion from the study are the age of published scientific works, exceeding a twenty-year period, and inconsistency with the chosen top.Results. The conducted analysis demonstrates the fundamental role of epigenetic factors and molecular genetic predisposition in patients in the progression of genital prolapse which makes it possible to develop personalized prediction and prevention of pelvic floor dysfunction in women, prevention of social burnout.Conclusion. Further study of the mechanisms of formation, determination of the most significant molecular and genetic polymorphisms that increase the risk of pelvic organ prolapse in women, is a promising vector of scientific research. These studies will help to form a pathophysiological basis that allow for a thorough examination to identify a predisposition to the development of a severe disease long before its occurrence.

Biomechanics of the Rat Vagina During Pregnancy and After Vaginal Delivery: A 3-Dimensional Ultrasound Approach

2013 ◽  
Author(s):  
Andrew Feola ◽  
Masayuki Endo ◽  
Jan Deprest
Keyword(s):  
Pelvic Organ Prolapse ◽  
Sexual Dysfunction ◽  
Fecal Incontinence ◽  
Connective Tissue ◽  
Pelvic Floor ◽  
Support System ◽  
Pelvic Floor Disorders ◽  
Focal Point ◽  
Pelvic Organ ◽  
3 Dimensional

The vagina plays a focal point in support by directly supporting the bladder, urethra, uterus, and rectum. The vagina also is a central location for connective tissue and muscle attachments. Failure in any component of this intricate support system can lead to the development of pelvic floor disorders, such as pelvic organ prolapse (POP), urinary and fecal incontinence and sexual dysfunction.

scholarly journals Laparoscopic sacral hysteropexy for pelvic organ prolapse in a patient affected by marfan syndrome: a case report

2021 ◽  
Vol 13 (4) ◽  
pp. 399-403
Author(s):  
G Campagna ◽  
L Vacca ◽  
D Caramazza ◽  
G Panico ◽  
S Mastrovito ◽  
...  
Keyword(s):  
Case Report ◽  
Pelvic Organ Prolapse ◽  
Connective Tissue ◽  
Marfan Syndrome ◽  
Pelvic Organ ◽  
Safe Procedure ◽  
Sexual Distress ◽  
Pop Surgery ◽  
Distress Scale ◽  
Sacral Hysteropexy

Background: Marfan Syndrome (MS) is a dominantly inherited connective tissue disorder with consequences on the strength and resilience of connective tissues that may predispose to Pelvic Organ Prolapse (POP). Literature lacks studies investigating POP surgery in patients affected by MS that might help surgical management decisions. Objective: The objective of this paper is to describe the surgical procedure of laparoscopic sacral hysteropexy (LSHP) in a 37 years old woman affected by MS with symptomatic POP. Materials and Methods and main outcome measures: We performed a nerve-sparing laparoscopic sacral hysteropexy without complications and looked for anatomical and subjective outcomes. The patient completed The Female Sexual Distress Scale (FSDS), Pelvic Floor Disability Index (PFDI-20), and Wexner questionnaires preoperatively and postoperatively. Results: The patient stated a complete resolution of all POP related symptoms and there was a total correction of the descensus. Furthermore, no perioperative and postoperative complications were noted. Conclusions: LSHP could be an effective and safe procedure for the treatment of POP in women affected by MS and this case report is the first to describe a reconstructive procedure in this category of patients. What is new? The literature lacks studies investigating POP surgery in women with MS, that might help surgeons, thus we present this case to describe surgical and functional outcomes in this patient category, underlying the higher risk of complications and relapses related to the weakness of connective tissue. This case report may represent the basis of future studies to confirm the safety, efficacy and feasibility of LSHP and sacral colpopexy in patients with MS.

The role of neuromuscular electrical stimulation in the rehabilitation of the pelvic floor muscles

2019 ◽  
Vol 28 (15) ◽  
pp. 968-974 ◽  
Author(s):  
Eleanor F Allon
Keyword(s):  
Urinary Incontinence ◽  
Electrical Stimulation ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Neuromuscular Electrical Stimulation ◽  
Pelvic Organ ◽  
Pelvic Floor Muscles ◽  
Significant Benefit

Pelvic floor dysfunction is a common problem, particularly for women. A weakness in the pelvic floor muscles can lead to one or more disorders developing, such as urinary incontinence or a pelvic organ prolapse. To combat this, it is advised that the pelvic floor muscles are exercised to strengthen them and help them become more supportive. However, more than 30% of women are unable to detect their pelvic floor muscles to produce an effective contraction. The introduction of neuromuscular electrical stimulation (NMES) in pelvic healthcare poses a significant benefit in the rehabilitation of the pelvic floor muscles.

scholarly journals Focused radiofrequency treatment of postpartum vaginal relaxation syndrome

2020 ◽  
Vol 14 (4) ◽  
pp. 437-448
Author(s):  
Yu. E. Dobrokhotova ◽  
T. S.K. Nagieva ◽  
E. N. Kareva
Keyword(s):  
Pelvic Organ Prolapse ◽  
Connective Tissue ◽  
Pelvic Floor ◽  
Postpartum Period ◽  
Pelvic Organ ◽  
Main Group ◽  
Diagnostic Methods ◽  
Positive Effects ◽  
Radiofrequency Treatment ◽  
Before And After

Aim: to assess the efficacy and safety of non-ablative radiofrequency treatment in the postpartum period in patients with vaginal relaxation syndrome and other initial manifestations of pelvic floor dysfunction (PFD).Materials and Methods. 44 patients with complaints of the initial manifestations of PFD were enrolled into prospective randomized comparative study: 30 women in the main group and 14 in the control group. Diagnostic methods included medical history collection, objective examination, assessing condition of the perineum by visual inspection; standard clinical and laboratory studies; using the questionnaire for calculating the Female Sexual Function Index (FSFI-19). Staging of pelvic organ prolapse was performed according to the POP-Q classification (Pelvic Organ Prolapse Quantification system). Measurement of the pelvic floor muscle contraction strength was performed by using a perineometer. A course of 3 procedures of radiofrequency non-ablative exposure of the vulvovaginal tissues in patients from the main group was performed 2 months after delivery, with 7-day interval. Assessment of the collagenogenesis and neoangiogenesis was carried out base on measuring expression level of the mRNA specific to proteins of the vaginal connective tissue by using real-time polymerase chain reaction.Results. Our study allowed to find that anatomical and functional state of the vulvovaginal area and perineum were significantly improved as well as relief of PFD symptoms. The level of expression of decorin mRNA in patients from the main group before and after treatment were 0.1 ± 0.035 and 0.047 ± 0.002, respectively (p = 0.02, Wilcoxon t-test). The median values of mRNA expression of matrix metalloproteinase type 2 before and after treatment were 0.0177 and 0.013, respectively (p = 0.03). The expression of type III collagen mRNA before and after treatment was 0.0675 and 0.0109, respectively (p = 0.03).Conclusion. The data obtained by us demonstrate positive effects after using monopolar radiofrequency therapy on the tissues in the vulva, vagina and perineum of patients in the postpartum period. However, clinical improvement in patients with PFD represents a cumulative result of morphological and functional changes in the tissues of the perineum as well as vulvovaginal region. We believe it is irrational to associate such positive effects solely with altered magnitude of the metabolism of collagen and other extracellular matrix proteins, due to dynamic balance and genetic determinism of decay and production of connective tissue proteins. The safety and role of radiofrequency therapeutic procedures in prevention and treatment of PFD require further investigation by assessing new markers and research methods, by extending observation period as well as increasing amount and quality of clinical observations.

Support role undifferentiated connective tissue dysplasia in genital organ rolapse evolution

2021 ◽  
Author(s):  
М.С. Селихова ◽  
В.В. Скворцов ◽  
Г.В. Ершов ◽  
А.Г. Ершов ◽  
Г.И. Малякин
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Connective Tissue ◽  
Pelvic Floor ◽  
Connective Tissue Diseases ◽  
Significant Risk ◽  
Genital Prolapse ◽  
Pelvic Organ ◽  
Genital Organ ◽  
Connective Tissue Dysplasia

Одним из наиболее значимых факторов риска формирования опущений и выпадений внутренних половых органов являются заболевания соединительной ткани. Неуклонный рост числа женщин, страдающих пролапсом органов малого таза, привел к тому, что данная патология стала как медицинской, так и социально-экономической проблемой во многих странах. В то же время данные о роли недифференцированных дисплазий соединительной ткани в развитии пролапса органов малого таза и в формировании недостаточности тазового дна и возможности использования ее с целью прогнозирования данной патологии разноречивы. С целью определения взаимосвязи проявления недифференцированных дисплазий соединительной ткани с развитием пролапса органов малого таза был проведен ретроспективный анализ 157 историй болезни пациенток с пролапсом гениталий. У 27,39% пациенток были отмечены проявления дисплазий соединительной ткани. В 39,53% случаев было выявлено сочетание проявления недифференцированных дисплазий соединительной ткани с родовым травматизмом. У 16,28% от количества случаев с родовым травматизмом и пролапсом органов малого таза выявлены выраженные формы дисплазии соединительной ткани (варикозное расширение вен нижних конечностей, полипоз кишечника, пролапс митрального клапана), потребовавшие хирургической коррекция до беременности или после родов. Выявленная у каждой третьей пациентки, оперированной по поводу несостоятельности тазового дна, недифференцированная дисплазия соединительной ткани позволяет рассматривать ее как фактор риска развития пролапса органов малого таза, особенно в сочетании с травматизацией промежности в родах. Однако для оценки роли и значимости патологии соединительной ткани в прогнозировании формирования опущения и выпадения внутренних половых органов малого таза у женщин необходимы проспективные рандомизированные исследования. One of the most significant risk factors for the formation of internal genital organs is connective tissue diseases. The steady increase in the number of women suffering from pelvic organ prolapse has led to the fact that this pathology has become both a medical and socio-economic problem in many countries. At the same time, the data on the role of undifferentiated connective tissue dysplasias in the development of pelvic organ prolapse and in the formation of pelvic floor insufficiency and the possibility of using it to predict this pathology are contradictory. To determine the relationship between the manifestation of undifferentiated connective tissue dysplasia and the development of pelvic organ prolapse, a retrospective analysis of 157 case histories of patients with genital prolapse was carried out. In 27,39% of patients, manifestations of connective tissue dysplasia were noted. In 39,53% of cases, a combination of the manifestation of undifferentiated connective tissue dysplasias with birth traumatism was revealed. Severe forms of connective tissue dysplasia (varicose veins of the lower extremities, intestinal polyposis, mitral valve prolapse) were found in 16,28% of the number of cases with birth traumatism and pelvic organ prolapse, which required surgical correction before pregnancy or after childbirth. Revealed in every third patient operated on for pelvic floor incompetence, undifferentiated connective tissue dysplasias allows us to consider it as a risk factor for pelvic organ prolapse, especially in combination with perineal trauma during childbirth. However, to assess the role and significance of connective tissue pathology in predicting the formation of prolapse and prolapse of the internal genital organs of the small pelvis in a woman, prospective randomized studies are needed. Keywords: genital prolapse, connective tissue dysplasia, risk factors, social-active age, surgical treatment.

scholarly journals Quo Vadis Urogynecology 2020 – Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse

2021 ◽  
Vol 81 (02) ◽  
pp. 183-190
Author(s):  
Gert Naumann
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Professional Training ◽  
Pelvic Floor Dysfunction ◽  
Estrogen Therapy ◽  
Pelvic Organ ◽  
Alloplastic Materials ◽  
Wide Range ◽  
Quo Vadis

AbstractThe current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patientʼs state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.

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