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Vaginal Bipolar Radiofrequency Treatment of Mild SUI: A Pilot Retrospective Study. Medicina (B Aires) 2022; 58:medicina58020181. [PMID: 35208505 PMCID: PMC8878952 DOI: 10.3390/medicina58020181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: This retrospective study investigates the action of a bipolar, temperature controlled, endovaginal RF handpiece for the treatment of mild, moderate, and severe stress urinary incontinence with a minimally invasive approach. Stress urinary incontinence (SUI) is a common condition resulting in involuntary urine leakage, with an associated social and psychological impact. SUI is the most common type of urinary incontinence in women. Materials and Methods: We retrospectively studied 54 patients for this study. The bipolar radiofrequency energy used in all patients was 50 W, with temperatures maintained between 41 °C and 44 °C. Two sessions were performed four weeks apart. In order to monitor all patients before the first treatment and 4 months after the second treatment, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used. Paired Student’s t test was used to elaborate the statistical data. Results: The average frequency of urine leak improved from “2–3 times a week” (2.1 ± 1.3 points before the treatment) to “once a week” (0.8 ± 1.3 points 4 MFU post-treatment). The average volume improved from “small/moderate quantity” (3.2 ± 1.6 points before the treatment) to “none” (0.9 ± 1.4 points 4 MFU post-treatment). No adverse events or side effects were found. Conclusion: Our preliminary results represent a good starting point to check the effectiveness and validity of the bipolar radiofrequency temperature-controlled method in the treatment of SUI.
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Pinheiro C, Costa T, Amorim de Jesus R, Campos R, Brim R, Teles A, Vilas Boas A, Lordêlo P. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study. BMC Womens Health 2021; 21:379. [PMID: 34717608 PMCID: PMC8557609 DOI: 10.1186/s12905-021-01518-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Genitourinary syndrome of menopause (GSM) involves vaginal dryness (VD), pain during sexual activity (SAPain), vaginal itching (VI), burning, pain, and symptoms in the urinary organs. Non-ablative radiofrequency (RF) is a type of current with electromagnetic waves with a thermal effect that generates an acute inflammatory process with consequent neocolagenesis and neoelastogenesis. We aimed to describe the clinical response to VD, SAPain, vaginal laxity (VL), VI, burning sensation, pain in the vaginal opening, urinary incontinence, sexual dysfunction, cytological changes, and adverse effects of non-ablative RF in patients with GSM. METHODS This single-arm pilot study included 11 women diagnosed with GSM with established menopause. Patients with hormone replacement initiation for six months, who used a pacemaker, or had metals in the pelvic region, were excluded. Subjective measures (numeric rating scale of symptoms, Vaginal Health Index-VHI) and objective measures (vaginal maturation index-VMI, vaginal pH, sexual function by the FSFI, and urinary function by the ICIQ-SF) were used. A Likert scale measures the degree of satisfaction with the treatment. Five sessions of monopolar non-ablative RF (41°C) were performed with an interval of one week between each application. The entire evaluation was performed before treatment (T0), one month (T1), and three months (T2) after treatment. Adverse effects were assessed during treatment and at T1 and T2. RESULTS The symptoms and/or signs were reduced after treatment in most patients (T1/T2, respectively): VD 90.9%/81.8%, SAPain 83.3%/66.7, VL 100%/100%, VI 100%/100%, burning 75%/87.5%, pain 75%/75%, and VHI 90.9%/81.9%. Most patients did not show changes in VMI (54.5%) and pH (63.6%) at T1, but there was an improvement in VMI in most patients (54.5%) at T2. Nine patients were satisfied, and two were very satisfied at T1. The treatment was well tolerated, and no adverse effects were observed. There was an improvement in sexual function (72.7%) and urinary function (66.7% in T1 and 83.3% in T2). CONCLUSION Intravaginal RF reduced the clinical symptoms of GSM in most patients, especially during T1, and women reported satisfaction with treatment. The technique showed no adverse effects, and there were positive effects on sexual and urinary function. Trial registration This research was registered at clinicaltrial.gov (NCT03506594) and complete registration date was posted on April 24, 2018.
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Affiliation(s)
- Cintia Pinheiro
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
- Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, Bahia, 41150-000, Brazil
| | - Teresa Costa
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
| | - Raira Amorim de Jesus
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
| | - Raquel Campos
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
| | - Rosa Brim
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
| | - Alcina Teles
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
| | - Andrea Vilas Boas
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
| | - Patrícia Lordêlo
- Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, 40290000, Brazil.
- Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil.
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Abdelaziz A, Dell J, Karram M. Transvaginal radiofrequency energy for the treatment of urinary stress incontinence: A comparison of monopolar and bipolar technologies in both pre- and post-menopausal patients. Neurourol Urodyn 2021; 40:1804-1810. [PMID: 34288106 DOI: 10.1002/nau.24748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
AIM A study to compare the effect of two different radio frequency energy models (mono polar and bipolar) for the treatment of urinary stress incontinence. METHODS Retrospective chart review, which was conducted at 2 sites, 69 patients received treatment with a bipolar radiofrequency device. Out of those 69 patients, 13 patients received bipolar in conjugation with CO2 laser treatment, while 32 patients received monopolar frequency. The study protocol normally consists of three sessions of treatment. Each session was four weeks apart with a whole 6-month duration follow-up. Results were evaluated by urogenital distress inventory (UDI)-6 questionnaire before and after treatment. RESULTS The bipolar group improved UDI-6 scores across time more so than did the monopolar group with some evidence suggesting that the bipolar radiofrequency treatment was more effective compared to the monopolar radiofrequency. Three months after treatment, the bipolar group UDI-6 values were lower than those of the monopolar group. Six months after treatment, the UDI-6 scores increased in both groups, suggesting decrease efficacy with time however, the bipolar group's UDI-6 scores were consistently lower than the monopolar group's scores. CONCLUSION This study shows benefit of both monopolar and bipolar radiofrequency device in patients with stress urinary incontinence and mixed UI, with bipolar RF more efficacious than monopolar RF. More randomized prospective studies are needed to confirm these findings.
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Affiliation(s)
- Ahmed Abdelaziz
- Division of Urogynecology, OBGYN Department, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffrey Dell
- OBGYN Department, Institute for Female Pelvic Medicine, Knoxville, Tennessee, USA
| | - Mickey Karram
- Division of Urogynecology, OBGYN Department, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA
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Liu X, Wang S, Wu S, Hao Q, Li Y, Guo Z, Wang W. Exosomes secreted by adipose-derived mesenchymal stem cells regulate type I collagen metabolism in fibroblasts from women with stress urinary incontinence. Stem Cell Res Ther 2018; 9:159. [PMID: 29895333 PMCID: PMC5998545 DOI: 10.1186/s13287-018-0899-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mesenchymal stem cells (MSC) have gained credibility as a therapeutic tool partly due to their potential to secrete factors such as cytokines and chemokines. Recently, exosomes, which mediate intercellular communication by delivering biomolecules such as mRNA and miRNA into recipient cells, have gained attention as a new and valuable therapeutic strategy in regenerative medicine. However, the potential role of exosomes secreted by adipose-derived mesenchymal stem cells (adMSC-Exos) in collagen metabolism is not well understood. The purpose of this study was to evaluate the effects of adMSC-Exos on collagen metabolism in cultured fibroblasts from women with stress urinary incontinence (SUI). METHODS Periurethral vaginal wall tissues of postmenopausal women with or without SUI were collected during transvaginal surgical procedures. Primary fibroblasts were cultured from periurethral vaginal wall tissues, and the levels of type I collagen mRNA and protein were examined by qRT-PCR and western blotting. MSC were isolated from human adipose tissue by enzymatic digestion. Exosomes were prepared by ultracentrifugation of adMSC-conditioned medium (adMSC-CM) and were confirmed by transmission electron microscopy and western blot analyses. The effects of adMSC-CM and adMSC-Exos were assessed using qRT-PCR and western blotting. RESULTS The type I collagen content was significantly decreased in periurethral vaginal wall tissues and cultured vaginal fibroblasts from women with SUI. adMSC-CM increased the expression of the col1a1 gene in vaginal fibroblasts from women with SUI. adMSC-Exos could be successfully isolated from adMSC-CM and could be transferred to fibroblasts efficiently. adMSC-Exos increased the expression of col1a1 in vaginal fibroblasts from women with SUI, and when the fibroblasts were treated with adMSC-Exos, the expression levels of TIMP-1 and TIMP-3 in fibroblasts were upregulated, with significant downregulation of MMP-1 and MMP-2 expression levels. CONCLUSIONS adMSC-Exos increased type I collagen contents by increasing collagen synthesis and decreasing collagen degradation in vaginal fibroblasts from women with SUI. adMSC-Exos may be a novel therapeutic approach for treating SUI.
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Affiliation(s)
- Xiaochun Liu
- Department of O/G, Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital, Shanxi Da Yi Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, China
| | - Shiwei Wang
- School of Medicine, University of Tasmania, Hobart, 7000, Australia
| | - Suhui Wu
- Department of O/G, Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital, Shanxi Da Yi Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, China
| | - Qian Hao
- Department of O/G, Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital, Shanxi Da Yi Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, China
| | - Ying Li
- Department of O/G, Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital, Shanxi Da Yi Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, China
| | - Zhuodan Guo
- Department of O/G, Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital, Shanxi Da Yi Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, China
| | - Wenzhen Wang
- Department of O/G, Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital, Shanxi Da Yi Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, China
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Marini G, Piculo F, Vesentini G, Damasceno DC, Delella FK, Calderon IMP, Daneshgari F, Felisbino SL, Barbosa AMP, Rudge MVC. The influence of hyperglycemia on the remodeling of urethral connective tissue in pregnant rats. Eur J Obstet Gynecol Reprod Biol 2017; 221:81-88. [PMID: 29275277 DOI: 10.1016/j.ejogrb.2017.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze the distribution and quantification of the key structural extracellular matrix components of the urethral tissue in a rat model of hyperglycemia and pregnancy. STUDY DESIGN A total of 120 female Wistar rats were distributed into the following four experimental groups: virgin, pregnant, hyperglycemic and hyperglycemic + pregnant groups. The urethra was harvested for histochemical, morphometric, immunohistochemical, Western blot and glycosaminoglycan analyses. All protocols were approved by the Institutional Animal Care and Use Committee of Botucatu Medical School (process number 828-2010). RESULTS The hyperglycemic + pregnant group showed significantly increased stiffness in urethral tissue. The total striated muscle was decreased, with increased deposition of collagen fibers around the muscle fibers and a change in the organization of the collagen fibrils. An increase in the relative collagen type I/III ratio and a decrease in total glycosaminoglycans were also observed. CONCLUSIONS This study provides the first line of experimental evidence supporting a metabolic relationship between hyperglycemia and urethral remodeling of connective tissue in pregnant rats. The different organization of the collagen fibrils and the profile of glycosaminoglycans found in urethral samples suggest that the pathology of the urethral fibromuscular system could be related to hyperglycemia-induced pelvic floor dysfunction in women, which has direct clinical implications with the possibility to develop new multidisciplinary treatments for improving the health care of these women.
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Affiliation(s)
- Gabriela Marini
- Universidade do Sagrado Coração (USC), Bauru, São Paulo, Brazil; UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil.
| | - Fernanda Piculo
- UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil
| | - Giovana Vesentini
- UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil
| | - Débora C Damasceno
- UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil
| | - Flávia K Delella
- UNESP - Univ Estadual Paulista, Institute of Biosciences, Department of Morphology, Botucatu, São Paulo, Brazil
| | - Iracema M P Calderon
- UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil
| | - Firouz Daneshgari
- Case Western Reserve University, Department of Urology, Cleveland, OH, USA
| | - Sérgio L Felisbino
- UNESP - Univ Estadual Paulista, Institute of Biosciences, Department of Morphology, Botucatu, São Paulo, Brazil
| | - Angélica M P Barbosa
- UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil
| | - Marilza V C Rudge
- UNESP - Univ Estadual Paulista, Botucatu Medical School, Department of Gynecology and Obstetrics, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu, São Paulo, Brazil
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Lordelo P, Boas AV, Sodré D, Lemos A, Tozetto S, Brasil C. New concept for treating female stress urinary incontinence with radiofrequency. Int Braz J Urol 2017; 43:896-902. [PMID: 28727373 PMCID: PMC5678521 DOI: 10.1590/s1677-5538.ibju.2016.0621] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/26/2017] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. MATERIALS AND METHODS This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. RESULTS Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. CONCLUSION The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.
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Affiliation(s)
- Patrícia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Fisioterapeutas e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil
| | - Andrea Vilas Boas
- Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Programas de Ginecologia e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil
| | - Danielle Sodré
- Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Fisioterapeutas e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil
| | - Amanda Lemos
- Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Fisioterapeutas e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil
| | - Sibele Tozetto
- Divisão de Ciências Morfofuncionais, Universidade Federal do Recôncavo Baiano, BA, Brasil
| | - Cristina Brasil
- Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Fisioterapeutas e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil
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Bulchandani S, Toozs-Hobson P. Urogynecological effects of menopause. Expert Rev Endocrinol Metab 2014; 9:73-77. [PMID: 30743740 DOI: 10.1586/17446651.2014.866893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The menopause signifies a period after significant hormonal change that affects all estrogen-sensitive tissues. This change may result in symptoms affecting any part of the urogenital system. These changes can significantly affect women's health and quality of life. The menopause is associated with lower urinary tract symptoms, vulvovaginal symptoms and pelvic organ prolapse. In this article, we have aimed to describe the symptomatology along with pathophysiology of the effects of menopause on urogynecological problems affecting women's health. Other factors apart from menopause add to these symptoms, like parity, mode of delivery, obesity, smoking and poor psychological health.
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Affiliation(s)
- Supriya Bulchandani
- a Birmingham Women's Hospital, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TG, UK
| | - Philip Toozs-Hobson
- a Birmingham Women's Hospital, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TG, UK
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Zhou L, Lee JH, Wen Y, Constantinou C, Yoshinobu M, Omata S, Chen B. Biomechanical properties and associated collagen composition in vaginal tissue of women with pelvic organ prolapse. J Urol 2012; 188:875-80. [PMID: 22819408 DOI: 10.1016/j.juro.2012.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE The pelvic tissue of women with pelvic organ prolapse is stiffer than that of controls but there are scant data on the collagen composition that corresponds to these mechanical properties. We evaluated human vaginal wall stiffness using the novel scanning haptic microscope and correlated these measurements to collagen expression in women with and without pelvic organ prolapse. In this simultaneous biomechanical and biochemical assessment we evaluated the usefulness of this measurement technology for pelvic floor disorder research and confirmed an association between mechanical properties and composition. MATERIALS AND METHODS The elastic constant (a measure of stiffness) of vaginal wall tissue was measured with the scanning haptic microscope. Protein expression of collagen types I and III of the same tissues were determined by Western blot. The Student t test was used for comparisons between groups. RESULTS The anterior and posterior vaginal walls of premenopausal and postmenopausal women with pelvic organ prolapse were significantly stiffer than those of controls (p <0.05). Collagen III protein expression in the anterior vaginal wall in the control group was higher than in menopausal women. Collagen I expression was not significantly different between controls and cases. CONCLUSIONS The scanning haptic microscope produced reliable mechanical measurements in small tissue samples without tissue destruction. Vaginal wall tissues are stiffer in women with pelvic organ prolapse than in controls. This vaginal wall stiffness was associated with lower protein expression of collagen III in the vaginal wall compared to that in asymptomatic controls.
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Affiliation(s)
- Lu Zhou
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, California 94305, USA
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Wang G, Lin G, Zhang H, Qiu X, Ning H, Banie L, Fandel T, Albersen M, Lue TF, Lin CS. Effects of prolonged vaginal distension and β-aminopropionitrile on urinary continence and urethral structure. Urology 2011; 78:968.e13-9. [PMID: 21982017 DOI: 10.1016/j.urology.2011.07.1381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 06/24/2011] [Accepted: 07/09/2011] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the effects of prolonged vaginal distension and β-aminopropionitrile (BAPN) on the urinary patterns and urethral structure in female virgin rats. METHODS A total of 21 female virgin rats were randomly divided into 3 groups of 7 rats each. The control group received no intervention; the vaginal distension (VD) group was treated with prolonged VD by balloon inflation; and the VD plus BAPN group was treated with VD plus intraperitoneal injection of 150 mg/kg of BAPN every 3 days. Three weeks later, all the rats underwent conscious cystometric analysis and were then killed for histologic analysis of the urethra. RESULTS Conscious cystometry identified 0, 3, and 5 rats in the control, VD, and VD plus BAPN groups with an abnormal voiding pattern, respectively. The urethral collagen content was significantly lower in the VD and VD plus BAPN rats compared with the control rats. The urethral elastic fibers were disorganized and shorter in the VD and VD plus BAPN rats and were fragmented and lacking the intermuscle connections in the VD plus BAPN rats. The urethral striated muscle fibers were shorter and more widely spaced in the VD and VD plus BAPN rats than in the control rats. Additionally, those in the VD plus BAPN group exhibited an abnormal wavy shape suggestive of a lack of architectural support. CONCLUSION Prolonged vaginal distension caused urodynamic changes and histologic abnormalities in the urethra, including reduced collagen content, fragmented elastic fibers, and sparsely arranged and shortened striated muscle fibers. BAPN appears to interfere with the restoration of collagen and elastic fibers.
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Affiliation(s)
- Guifang Wang
- Department of Urology, University of California, School of Medicine, San Francisco, CA, USA
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Ruano JM, Feldner PC, Takano CC, Castro RA, Nader HB, Sartori MGF, Girão MJBC. Impact of birth in the presence and absence of simulated birth injury on vaginal glycosaminoglycan content. Int Urogynecol J 2011; 22:1513-9. [PMID: 21850509 DOI: 10.1007/s00192-011-1514-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 07/11/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to evaluate the effects of simulated birth trauma and vaginal and Cesarean delivery on glycosaminoglycans (GAGs) in the vagina of female rats. METHODS One hundred ten rats were divided into six groups: A (control), B (vaginal trauma), C (Cesarean delivery), D (Cesarean delivery followed by vaginal trauma), E (vaginal delivery), and F (20th day of gestation). In each group, half of the animals were killed 4 days after the procedure (time 1) and 12 weeks later (time 2). GAGs were extracted, isolated, and identified by using agarose gel electrophoresis and quantified by densitometry. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney tests. RESULTS We observed a significant decrease in total GAGs and dermatan sulfate (DS) at time 1. Evaluation at time 2 showed a significant increase in total GAGs, DS, and heparan sulfate. CONCLUSIONS Levels of sulfated GAGs in the rat vagina are affected by delivery and simulated birth trauma.
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Affiliation(s)
- José Maria Ruano
- Section of Urogynecology and Pelvic Surgery/Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Franco GR, de Oliveira E, Baracat EC, Simões MDJ, Sartoria MGF, Girão MJBC, Castro RA. Histomorphometric analysis of a rat bladder after electrical stimulation. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Franco GR, de Oliveira E, Baracat EC, de Jesus Simões M, Ferreira Sartoria MG, Castello Girão MJB, Castro RA. Histomorphometric analysis of a rat bladder after electrical stimulation. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kati LM, Feldner PC, de Castro RA, Kobayashi EY, Sartori MGF, Nader HB, Castello Girão MJB. Analysis of Glycosaminoglycans in the Parametrium and Vaginal Apex of Women with and without Uterine Prolapse. J Womens Health (Larchmt) 2010; 19:1341-4. [DOI: 10.1089/jwh.2009.1567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lea Mina Kati
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Paulo Cezar Feldner
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Aquino de Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Elsa Yoko Kobayashi
- Department of Biochemistry, Federal University of São Paulo, São Paulo, Brazil
| | - Marair Gracio Ferreira Sartori
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Helena B. Nader
- Department of Biochemistry, Federal University of São Paulo, São Paulo, Brazil
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Knuuti E, Kauppila S, Kotila V, Risteli J, Nissi R. Genitourinary prolapse and joint hypermobility are associated with altered type I and III collagen metabolism. Arch Gynecol Obstet 2010; 283:1081-5. [PMID: 20502906 DOI: 10.1007/s00404-010-1518-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 05/10/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to determine whether benign joint hypermobility (BJH) is associated with urogenital prolapse and altered collagen metabolism. METHODS 43 postmenopausal women with previous vaginal hysterectomy operated due to genitourinary prolapse were recruited. Each patient was also evaluated for joint hypermobility. The collagen metabolism was studied measuring serum concentrations of type I and III procollagen aminoterminal propeptides and trivalently cross-linked carboxyterminal telopeptide of type I collagen. RESULTS Clinical joint hypermobility was found in 35% patients. Women with joint hypermobility had higher concentration of aminoterminal propeptide for type I procollagen and the values were statistically significant (P < 0.0178). Recurrent prolapse was found in 47% of the patients with BJH as compared to non-hypermobile group (25%). In this subgroup the results were statistically significant (P < 0.0085) for type III collagen. Also, the mean serum concentration for type III procollagen was significantly increased above the reference limit. CONCLUSIONS Women with joint hypermobility have more recurrent genital prolapse as compared to women with normal joint mobility. Plain hypermobility was associated with higher concentrations for type I procollagen. Patients with recurrent prolapse and joint hypermobility have significantly high concentrations for type III procollagen.
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Affiliation(s)
- E Knuuti
- Department of Obstetrics and Gynecology, Länsi-Pohja Central Hospital, Kemi, Finland
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15
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Abstract
Normal physiologic function of the pelvic organs depends on the anatomic integrity and proper interaction among the pelvic structures, the pelvic floor support components, and the nervous system. Pelvic floor dysfunction includes urinary and anal incontinence; pelvic organ prolapse; and sexual, voiding, and defecatory dysfunction. Understanding the anatomy and proper interaction among the support components is essential to diagnose and treat pelvic floor dysfunction. The primary aim of this article is to provide an updated review of pelvic support anatomy with clinical correlations. In addition, surgical spaces of interest to the gynecologic surgeon and the course of the pelvic ureter are described. Several concepts reviewed in this article are derived and modified from a previous review of pelvic support anatomy.
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Affiliation(s)
- Marlene M Corton
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390 9032, USA.
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16
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Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause 2010; 17:204-12. [DOI: 10.1097/gme.0b013e3181b0c2ae] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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Metabolic profile of glycosaminoglycans in bladder and urethra of female rats during and after pregnancy. Int Urogynecol J 2009; 21:241-6. [DOI: 10.1007/s00192-009-1001-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
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18
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Dietz HP. The aetiology of prolapse. Int Urogynecol J 2008; 19:1323-9. [DOI: 10.1007/s00192-008-0695-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 07/09/2008] [Indexed: 12/28/2022]
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19
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Sulfated glycosaminoglycans of periurethral tissue in pre- and postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2008; 139:252-5. [DOI: 10.1016/j.ejogrb.2008.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 10/26/2007] [Accepted: 01/03/2008] [Indexed: 11/24/2022]
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20
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Augsburger H, Henzi D. Immunohistochemical expression of collagen types I, III, IV and α-actin in the uterine horns of nulliparous and multiparous beagles. Theriogenology 2008; 69:1070-6. [DOI: 10.1016/j.theriogenology.2008.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 01/10/2008] [Accepted: 01/12/2008] [Indexed: 10/22/2022]
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21
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Rahn DD, Ruff MD, Brown SA, Tibbals HF, Word RA. Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol 2008; 198:590.e1-6. [PMID: 18455541 DOI: 10.1016/j.ajog.2008.02.022] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/20/2007] [Accepted: 02/11/2008] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to identify pregnancy-induced changes in biomechanical properties of the vaginal wall and to compare these with fibulin-5 knockout mice (Fbln5(-/-)) with and without prolapse. STUDY DESIGN Mid-vaginal segments of nonpregnant and late-pregnant wild-type mice, Fbln5(-/-) with prolapse mice and Fbln5(-/-) mice without prolapse were studied. Tissue length at failure, maximal strain, maximal stress, and tissue stiffness were determined. RESULTS Compared with nonpregnant mice, vaginas of pregnant and Fbln5(-/-) (with prolapse) mice exhibited decreased maximal stress, increased distensibility and strain, and decreased stiffness. Tissues from Fbln5(-/-) mice without prolapse were similar to nonpregnant wild-type animals. CONCLUSION Pregnancy confers remarkable changes in the vaginal wall that include increased distensibility and decreased stiffness and maximal stress. Elastinopathy alone is insufficient to cause significant changes in these properties, but prolapse confers additional alterations in distensibility and stiffness that are similar to those changes that have been observed in pregnancy. These changes may contribute to the poor durability of many restorative surgical procedures for prolapse.
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22
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Xie Z, Shi H, Zhou C, Dong M, Hong L, Jin H. Alterations of estrogen receptor-α and -β in the anterior vaginal wall of women with urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2007; 134:254-8. [PMID: 17287066 DOI: 10.1016/j.ejogrb.2006.10.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Revised: 08/31/2006] [Accepted: 10/27/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective was to investigate the alterations in estrogen receptor-alpha and -beta (ER-alpha and ER-beta) in the anterior vaginal wall of women with stress urinary incontinence (SUI). STUDY DESIGN Samples of the anterior vaginal wall were taken from 57 women, including 12 women with premenopausal SUI (pre-M SUI), 12 with premenopausal control (pre-M control), 19 with postmenopausal SUI (post-M SUI), and 14 with postmenopausal control (post-M control). The expressions of ER-alpha and ER-beta were assayed by immunohistochemistry and quantified with the H-score method. RESULTS Serum estradiol was significantly lower in the pre-M SUI than in the pre-M control group (P<0.01), but the difference between the post-M SUI and post-M control groups was not significant (P>0.05). ER-alpha in endothelia, smooth muscle cells, and fibrocytes were significantly lower in pre-M SUI than in pre-M control (P<0.01), but there were no significant differences of ER-alpha between the post-M SUI and post-M control groups (P>0.05). ER-beta in endothelia and fibrocytes were significantly lower in the pre-M SUI than in the pre-M control group (P<0.01), and ER-beta in fibrocytes was significantly lower in the post-M SUI than in the post-M control group (P<0.01). CONCLUSIONS Alterations in serum estradiol and its receptors (ER-alpha and ER-beta) in the anterior vaginal wall were demonstrated, suggesting their involvement in the occurrence of female SUI.
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Affiliation(s)
- Zhenwei Xie
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 2 Xueshi Road, Hangzhou 310006, PR China
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23
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Augsburger HR, Oswald M. Immunohistochemical analysis of collagen types I, III, IV and α-actin in the urethra of sexually intact and ovariectomized beagles. Int Urogynecol J 2007; 18:1071-5. [PMID: 17206491 DOI: 10.1007/s00192-006-0272-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 11/08/2006] [Indexed: 11/26/2022]
Abstract
Urinary incontinence is a widespread problem in both postmenopausal women and ovariectomized dogs. The objective of this study was to investigate the influence of ovariectomy on the immunoreactivity and the distribution pattern of collagens I, III, IV and alpha-actin in the canine urethra. The immunohistochemical results were evaluated in five sexually intact and five ovariectomized beagles. The immunostaining of both collagens I and III delineated urethral connective tissue fibres and co-localized within in the fibres of both groups. The basement membranes of smooth muscle cells and sinusoids showed marked type IV collagen expression, whereas only faint immunoreactivity was present at the urothelial-stromal interface. No differences could be detected in the expression or distribution of the assessed collagen types and actin between ovariectomized and control animals. In conclusion, ovariectomy does not appear to have an effect on urethral collagens I, III, IV and smooth muscle actin in the dog, as ascertained by immunohistochemistry.
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Affiliation(s)
- Heinz R Augsburger
- Institute of Veterinary Anatomy, Vetsuisse Faculty, University of Zürich, Winterthurerstr. 260, CH-8057 Zürich, Switzerland.
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24
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Lei L, Song Y, Chen R. Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women. Int Urogynecol J 2006; 18:603-7. [PMID: 17024520 DOI: 10.1007/s00192-006-0214-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
The aim of this study was to explore the relationship between biomechanical properties and the occurrence of pelvic organ prolapse (POP) through analysis on biomechanical properties of vaginal tissue. The biopsy specimens were obtained from 43 patients undergoing transvaginal hysterectomy, who were assigned into premenopausal POP, postmenopausal POP, premenopausal control and postmenopausal control groups. Tissue specimens were biomechanically assessed by a purpose-built tissue puller system, and stress-strain curves were digitally recorded. The Young's modulus, Poisson's ratio, maximum elongation, maximum fracture of vaginal tissue were 9.45 +/- 0.70, 0.43 +/- 0.01, 1.50 +/- 0.02, 0.60 +/- 0.02 in premenopausal POP group; 12.10 +/- 1.10, 0.39 +/- 0.01, 1.14 +/- 0.05, 0.27 +/- 0.03 in postmenopausal POP group; 6.65 +/- 1.48, 0.46 +/- 0.01, 1.68 +/- 0.11, 0.79 +/- 0.05 in premenopausal control group and 10.26 +/- 1.10, 0.42 +/- 0.01, 1.37 +/- 0.04, 0.42 +/- 0.03 in postmenopausal control group. There was significant difference in biomechanical properties between premenopausal POP group and premenopausal control group (p < 0.01). There was significant difference in biomechanical properties between postmenopausal POP group and postmenopausal control group (p < 0.01). Biomechanical properties in POP group were significantly lower than that in control group, suggesting that degeneration of biomechanical properties in pelvic support construction might lead to the occurrence of POP.
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Affiliation(s)
- Lingling Lei
- Department of Obstetrics and Gynecology, Fuzhou Dongfang Hospital, Fuzhou, 350025, Fujian, People's Republic of China
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25
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Viktrup L, Rortveit G, Lose G. Risk of Stress Urinary Incontinence Twelve Years After the First Pregnancy and Delivery. Obstet Gynecol 2006; 108:248-54. [PMID: 16880292 DOI: 10.1097/01.aog.0000226860.01127.0e] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. METHODS In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. RESULTS Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (P<.01) in women with onset during first pregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. CONCLUSION Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.
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Affiliation(s)
- Lars Viktrup
- Department of Obstetrics and Gynecology, Glostrup County Hospital, University of Copenhagen, Denmark.
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26
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Feldner PC, Kati LM, Sartori MGF, Baracat EC, Rodrigues de Lima G, Nader HB, Dietrich CP, Girão MJBC. Sulfated glycosaminoglycans of the periurethral tissue in women with and without stress urinary incontinence, according to genital prolapse stage. Eur J Obstet Gynecol Reprod Biol 2006; 126:250-4. [PMID: 16314024 DOI: 10.1016/j.ejogrb.2005.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Revised: 02/18/2005] [Accepted: 08/05/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective was to determine sulfated glycosaminoglycans (GAG) of the extracellular matrix (ECM) in women with and without stress urinary incontinence according to genital prolapse stage. STUDY DESIGN Periurethral tissue was obtained from 30 women who underwent surgery for urinary incontinence, for pelvic organ prolapse, or for other benign gynecologic conditions. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated glycosaminoglycans. Measurements were made of total glycosaminoglycans, chondroitin sulfate, dermatan sulfate, and of heparan sulfate. Data were compared using the t-test. RESULTS In two groups, dermatan sulfate was the most predominant glycosaminoglycan. Women with stress urinary incontinence had significantly more total sulfated glycosaminoglycans (p<0.05) and dermatan sulfate (p<0.05) than women without stress urinary incontinence. We did not observe any differences in chondroitin sulfate and heparan sulfate. CONCLUSIONS Women with stress urinary incontinence showed quantitative and qualitative differences in the biochemical characteristics of the extracellular matrix in periurethral tissue by analysis of sulfated glycosaminoglycans, according to genital prolapse stage.
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Affiliation(s)
- Paulo Cezar Feldner
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua dos Otonis 567, Vila Clementino, São Paulo, SP, Brazil.
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Skorupski P, Król J, Starega J, Adamiak A, Jankiewicz K, Rechberger T. An alpha-1 chain of type I collagen Sp1-binding site polymorphism in women suffering from stress urinary incontinence. Am J Obstet Gynecol 2006; 194:346-50. [PMID: 16458627 DOI: 10.1016/j.ajog.2005.07.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 05/16/2005] [Accepted: 07/05/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the possible influence of G-->T substitution in transcription factor Sp1-binding site in the gene encoding alpha-1 chain of type I collagen on the risk of stress urinary incontinence. STUDY DESIGN The study group consisted of 50 women reporting symptoms of stress urinary incontinence. Fifty control subjects were treated for benign gynecological conditions other then stress urinary incontinence. DNA was obtained from peripheral blood leukocytes. The fragment of the first intron of the gene encoding the alpha-1 chain of type I collagen containing the Sp1-binding site was amplified by polymerase chain reaction. The analysis of restriction fragment length polymorphism was performed. RESULTS We found association between the GT and TT genotype and stress urinary incontinence (P = .019). The odds ratio for developing stress urinary incontinence is 4.98 (95% confidence interval 1.97 to 12.56) in subjects presenting the GT genotype and 2.23 (95% confidence interval 0.69 to 7.25) for the TT genotype. CONCLUSION The G-T polymorphism at the Sp1 binding site of the gene encoding alpha-1 chain of type 1 collagen is associated with increased risk of stress urinary incontinence in women.
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Affiliation(s)
- Paweł Skorupski
- Second Department of Gynecological Surgery, Skubiszewski Medical University of Lublin, Poland.
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Altman D, Mellgren A, Zetterström J. Rectocele Repair Using Biomaterial Augmentation: Current Documentation and Clinical Experience. Obstet Gynecol Surv 2005; 60:753-60. [PMID: 16250924 DOI: 10.1097/01.ogx.0000182906.75926.cb] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Although the etiology of rectocele remains debated, surgical innovations are currently promoted to improve anatomic outcome while avoiding dyspareunia and alleviating rectal emptying difficulties following rectocele surgery. Use of biomaterials in rectocele repair has become widespread in a short time, but the clinical documentation of their effectiveness and complications is limited. Medline and the Cochrane database were searched electronically from 1964 to May 2005 using the Pubmed and Ovid search engines. All English language publications including any of the search terms "rectocele," "implant," "mesh," "biomaterial," "prolapse," "synthetical," "pelvic floor," "biological," and "compatibility" were reviewed. This review outlines the basic principles for use of biomaterials in pelvic reconstructive surgery and provides a condensation of peer-reviewed articles describing clinical use of biomaterials in rectocele surgery. Historical and new concepts in rectocele surgery are discussed. Factors of importance for human in vivo biomaterial compatibility are presented together with current knowledge from clinical studies. Potential risks and problems associated with the use of biomaterials in rectocele and pelvic reconstructive surgery in general are described. Although use of biomaterials in rectocele and other pelvic organ prolapse surgery offers exciting possibilities, it raises treatment costs and may be associated with unknown and potentially severe complications at short and long term. Clinical benefits are currently unknown and need to be proven in clinical studies. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians TARGET AUDIENCE After completion of this article, the reader should be able to explain that the objective of surgical treatment is to improve anatomic outcome and alleviate rectal emptying difficulties, describe the efficacy of biomaterials in rectocele repair, and summarize the potential risks and problems associated with use of biomaterials in rectocele and pelvic reconstructive surgery.
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Affiliation(s)
- Daniel Altman
- Pelvic Floor Center, Division of Obstetrics and Gynecology, The Karolinska Institute at Danderyd Hospital, 182-88 Stockholm, Sweden.
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Wood DN, Allen SE, Hussain M, Greenwell TJ, Shah PJR. STOMAL COMPLICATIONS OF ILEAL CONDUITS ARE SIGNIFICANTLY HIGHER WHEN FORMED IN WOMEN WITH INTRACTABLE URINARY INCONTINENCE. J Urol 2004; 172:2300-3. [PMID: 15538253 DOI: 10.1097/01.ju.0000141140.56022.7a] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The ileal conduit is held to be the safest and simplest form of urinary diversion. There are few reports about long-term problems after ileal conduit formation, especially intractable urinary incontinence in females. We reviewed long-term stomal complications in patients with an ileal conduit. MATERIALS AND METHODS Notes on 93 consecutive patients in whom an ileal conduit was created were reviewed. Information was collected on patient demographics, indications for an ileal conduit and long-term complications, in particular parastomal and incisional hernias, stomal retraction, stenosis or prolapse and the development of a redundant loop. Mean followup available was 63.4 months (range 1 to 434). RESULTS A total of 33 males with a mean age of 60.1 years (range 2 to 78) and 60 females with a mean age of 48.2 years (range 4 to 79) underwent ileal conduit diversion. The main indications for an ileal conduit were intractable incontinence in 44 patients (47%), cancer in 31 (33%) and interstitial cystitis in 8 (9%). In male, continent female and incontinent female patients A parastomal hernia developed in 3 (9%), 2 (9.5%) and 12 (31%), an incisional hernia developed in 1 (3%), 1 (4.8%) and 2 (5%), stomal retraction developed in 0, 2 (9.5%) and 12 (31%), stomal stenosis developed in 0 (0%), 1 (4.8%) and 6 (15.4%), and a redundant loop developed in 0 (0%), 2 (9.5%) and 5 (12.8%), respectively. A total of 23 patients (24.7%) required further surgery for stomal problems with 13 (57%) requiring more than 1 reoperation, of whom 9 were incontinent females. CONCLUSIONS An ileal conduit is associated with a stomal complication rate of 34.4% (61% in incontinent females and 18% in other patients) and a 4.3% incisional hernia rate. Reoperation is required for stomal complications in 24.7% of cases. Stomal complication rates and reoperation rates vary by sex and the indication for ileal conduit, and they are significantly higher for those performed for intractable urinary incontinence in females.
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Affiliation(s)
- D N Wood
- Institute of Urology, University College London, London, United Kingdom
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30
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Bezerra LRPS, Feldner PC, Kati LM, Girão MJBC, Sartori MG, Baracat EC, de Lima GR, Nader HB, Dietrich CP. Sulfated glycosaminoglycans of the vagina and perineal skin in pre- and postmenopausal women, according to genital prolapse stage. Int Urogynecol J 2004; 15:266-71. [PMID: 15517672 DOI: 10.1007/s00192-004-1150-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to analyze the amount and types of sulfated glycosaminoglycans (GAGs) of the extracellular matrix (ECM) in the posterior vaginal wall and perineal skin in menacme and postmenopausal women, according to genital prolapse stage. Samples of vaginal tissue and perineal skin were obtained from 40 women who underwent vaginal surgery. Sulfated glycosaminoglycans were extracted by extensive tissue maxatase digestion, submitted to electrophoresis on agarose gel, and their concentrations were determined by densitometry. Dermatan sulphate (DS) was the predominant GAG, followed by chondroitin sulfate (CS) and heparan sulfate (HS). In the vagina there was a significant decrease in total GAGs, CS, DS and HS in postmenopausal women with prolapse stage 2 and 3 compared to the premenopausal group, independent of the stage. In stage 2 and 3 postmenopausal patients there was a significant decrease of DS and HS compared to the stage 1 postmenopausal group. In perineal skin there was no significant difference between total GAG amount, DS and HS. However, the amount of CS in premenopausal stage 1 patients was significantly than that in postmenopausal patients stage 1 and stages 2 and 3. In conclusions, there are quantitative and qualitative differences in GAGs of the ECM in vaginal wall and perineal skin between women in menacme and the postmenopause, according to genital prolapse stage.
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Affiliation(s)
- Leonardo R P S Bezerra
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua dos Otonis 567, Vila Clementino, São Paulo, Brazil.
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Wong MY, Harmanli OH, Agar M, Dandolu V, Grody MHT. Collagen content of nonsupport tissue in pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol 2003; 189:1597-9; discussion 1599-1600. [PMID: 14710077 DOI: 10.1016/j.ajog.2003.09.043] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Reduction in the collagen content of the pelvic floor tissue of the patients with pelvic organ prolapse and/or stress urinary incontinence has been documented previously. However, this is less clear for nonsupport tissue. We aimed to compare the collagen content of the uterine cervix, a nonsupport tissue, of women who had pelvic organ prolapse with and without stress urinary incontinence against those without these problems. STUDY DESIGN Cervical collagen content was compared between 14 women who had pelvic organ prolapse with and without stress urinary incontinence and 17 controls without these conditions. Specimens were obtained after surgery for benign gynecologic conditions. RESULTS Groups were similar with respect to age, parity, body mass index, and tobacco use. Women who had pelvic organ prolapse with and without stress urinary incontinence possessed significantly less collagen compared with the controls (8.10%+/-3.43% vs 12.35%+/-4.72%, P=.0104). Furthermore age, parity, body mass index, or tobacco use had no significant relationship to collagen content. CONCLUSION Cervical collagen content is significantly decreased in women who have pelvic organ prolapse with and without stress urinary incontinence regardless of age, parity, body mass index, or tobacco use.
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Affiliation(s)
- Michael Y Wong
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
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Discussion. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cör A, Barbic M, Kralj B. Differences in the quantity of elastic fibres and collagen type I and type III in endopelvic fascia between women with stress urinary incontinence and controls. UROLOGICAL RESEARCH 2003; 31:61-5. [PMID: 12677309 DOI: 10.1007/s00240-002-0293-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2002] [Accepted: 11/14/2002] [Indexed: 10/25/2022]
Abstract
The aim of this study was to evaluate whether differences in the quantity of elastic fibres, collagen type I and collagen type III in the endopelvic fascia occur with female stress urinary incontinence (SUI). A total of 54 patients participated in the study. They were divided into two groups (continent and incontinent) that were comparable with respect to age and parity. All patients underwent gynaecologic surgical procedures and biopsies from the endopelvic fascia were obtained. Histological slides were stained with haematoxylin and eosin and Masson trichrome or Weigert's techniques and immunohistochemistry for either collagen type I or type III were performed. The elastic fibres constituted 3.81+/-0.6% and 5.93+/-0.92% of the cross-sectional area of the endopelvic fascia in incontinent and control groups of patients, respectively. Collagen type I and type III were not significantly reduced in patients with SUI. Our results suggest that the quantity of elastic and collagen fibres in the endopelvic fascia does not play a significant role in continence.
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Affiliation(s)
- Andrej Cör
- Institute for Histology and Embryology, Medical Faculty, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia.
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Abstract
PURPOSE OF REVIEW Numbers of women seeking consultation for pelvic floor disorders, a large portion of which will involve pelvic organ prolapse (POP) and lower urinary tract dysfunction, are expected to reach epidemic proportions within the next decade. A full understanding of the complex impact of pelvic organ prolapse on lower urinary tract function is crucial to successful management. RECENT FINDINGS Recent data lend support to the concept that women with POP, but no associated urethral dysfunction, may be best served by a surgical repair that carefully avoids dissection in the periurethral area. Conversely, preoperative evaluation will often reveal bladder outlet obstruction concomitant with 'hidden', 'potential', or 'occult' stress urinary incontinence when the prolapse is reduced. Many of these women will not have incontinence symptoms in daily life. Paradoxically, the mechanical bladder outlet obstruction may induce detrusor instability with subsequent obstructed/overactive bladder symptom complexes not dissimilar to those of men with prostatic bladder outlet obstruction. Anatomic research shows that the vessels and nerves supplying the urethra are particulary vulnerable to surgical techniques used in pelvic organ prolapse repair. SUMMARY This mix of obstructed, overactive bladder with hidden stress incontinence increases with degree of POP, and all women with severe prolapse will fair best if evaluated for all three conditions prior to surgical repair.
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Affiliation(s)
- Lauri J Romanzi
- Obstetrics and Gynecology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA.
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