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Jiang J, Chen B, Tang B, Li J, Zhang C, Tan D, Zhang T, Wei Q. Urinary phenols and parabens exposure in relation to urinary incontinence in the US population. BMC Public Health 2024; 24:515. [PMID: 38373965 PMCID: PMC10875867 DOI: 10.1186/s12889-024-17872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Our study aimed to investigate the impact of urinary concentrations of personal care products (PCPs)-related phenols (PNs) and parabens (PBs), including Triclosan (TCS), Bisphenol A (BPA), Benzophenone-3 (BP-3), Butylparaben (BPB), Ethylparaben (EPB), Methylparaben (MPB), and Propylparaben (PPB), on urinary incontinence (UI) occurrence. METHOD We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2007 to 2016. Regression analysis was employed to investigate the relationship between exposure to PCPs-related substances, various levels of exposure, and UI within both the general population and the female demographic. Additionally, the Bayesian Kernel Machine Regression (BKMR) model was used to assess the effects of mixtures on UI. RESULTS Our analysis comprised 7,690 participants who self-reported their diagnosis. Among them, 12.80% experienced stress urinary incontinence (SUI), 11.80% reported urge urinary incontinence (UUI), and 10.22% exhibited mixed urinary incontinence (MUI). In our fully adjusted multivariable models, BP-3 exposure exhibited a positive association with SUI (OR 1.07, 95% CI 1.02-1.14, p = 0.045). BPA exposure correlated with an increased risk of UUI (OR 1.21, 95% CI 1.01-1.44, p = 0.046) and MUI (OR 1.26, 95% CI 1.02-1.54, p = 0.029). TCS exposure displayed a negative correlation with the incidence of MUI (OR 0.87, 95% CI 0.79-0.97, p = 0.009). No significant links were observed between parabens and urinary incontinence. Notably, among the female population, our investigation revealed that BPA exposure heightened the risk of MUI (OR 1.28, 95% CI 1.01-1.63, p = 0.043). Participants in the highest tertile of BP-3 exposure demonstrated elevated likelihoods of SUI and MUI compared to those in the lowest tertile. In the BKMR analysis, negative trends were observed between the mixture and the risks of UUI and MUI when the mixture ranged from the 25th to the 40th and 35th to the 40th percentiles or above, respectively. Additionally, a positive trend was identified between the mixture and MUI when it was in the 40th to 55th percentile. CONCLUSION In conclusion, our findings suggest that exposure to BPA, TCS, and BP-3 may contribute to the development of urinary incontinence.
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Affiliation(s)
- Jinjiang Jiang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Bo Tang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Chensong Zhang
- State Key Laboratory of Biotherapy and Cancer Center, Frontiers Science Center for Disease-Related Molecular Network, and National Clinical Research Center for Geriatrics, Sichuan University, Chengdu, Sichuan, China
| | - Daqing Tan
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Ting Zhang
- School of Basic Medicine, Harbin Medical Hospital, Harbin, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China.
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Zhao Z, Huang G, He Y, Zuo X, Han W, Li H. Estrogen inhibits the differentiation of fibroblasts induced by high stiffness matrix by enhancing DNMT1 expression. Tissue Cell 2023; 85:102207. [PMID: 37708582 DOI: 10.1016/j.tice.2023.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse(POP) is a multifactorial connective tissue disorder caused by damage to the supporting structures of the pelvic floor. Evidence from several studies suggests that anterior vaginal wall stiffness is higher in patients with POP, but the mechanisms involved remain unknown. METHODS Tissue from the anterior vaginal wall of patients with POP or other benign diseases was obtained. The modulus of elasticity of the anterior vaginal wall was measured using a microindenter. Cells were cultured in vitro on acrylamide gels of different stiffness and treated with DNMT1 inhibitor, microtubule polymerisation inhibitor and estrogen. Western blot or immunohistochemical staining was performed to detect DNA Methyltransferase 1, α-smooth muscle actin(α-SMA) expression, and connective tissue growth factor(CTGF) expression. CONCLUSION Estrogen can inhibit high stiffness matrix-induced fibroblast differentiation, by enhancing DNMT1 expression. This study may help to elucidate the complex crosstalk between fibroblasts and their surrounding matrix under healthy and pathological conditions and provide new insights into the options for material-related therapeutic applications.
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Affiliation(s)
- Zhihan Zhao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Yong He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Xiaohu Zuo
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Wuyue Han
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Hong Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China.
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Orlicky DJ, Smith EE, Bok R, Guess MK, Rascoff LG, Arruda JS, Hutchinson-Colas JA, Johnson J, Connell KA. Estrogen and Androgen Receptor Status in Uterosacral Ligaments of Women with Pelvic Organ Prolapse Stratified by the Pelvic Organ Prolapse Histology Quantification System. Reprod Sci 2023; 30:3495-3506. [PMID: 37430099 PMCID: PMC10692001 DOI: 10.1007/s43032-023-01283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/02/2023] [Indexed: 07/12/2023]
Abstract
Menopause is a significant risk factor for pelvic organ prolapse (POP), suggesting that ovarian sex steroids play a major role in the etiology of the condition. POP results from failure of the uterine-cervix-vagina support structures, including the uterosacral ligament (USL). We previously identified consistent degenerative USL phenotypes that occur in POP and used their characteristics to develop a standardized POP Histologic Quantification System (POP-HQ). In this study, POP and matched control USL tissue was first segregated into the unique POP-HQ phenotypes, and specimens were then compared for estrogen receptor (ER) alpha (ERα), ERbeta (ERβ), the G-protein estrogen receptor (GPER), and androgen receptor (AR) content via immunohistochemical staining. ER and AR expression levels in the control USL tissues were indistinguishable from those observed in the POP-A phenotype, and partially overlapped with those of the POP-I phenotype. However, control-USL steroid receptor expression was statistically distinct from the POP-V phenotype. This difference was driven mainly by the increased expression of GPER and AR in smooth muscle, connective tissue, and endothelial cells, and increased expression of ERα in connective tissue. These findings support a multifactorial etiology for POP involving steroid signaling that contributes to altered smooth muscle, vasculature, and connective tissue content in the USL. Furthermore, these data support the concept that there are consistent and distinct degenerative processes that lead to POP and suggest that personalized approaches are needed that target specific cell and tissues in the pelvic floor to treat or prevent this complex condition.
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Affiliation(s)
- David J Orlicky
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - E Erin Smith
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel Bok
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marsha K Guess
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren G Rascoff
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jaime S Arruda
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Joshua Johnson
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kathleen A Connell
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
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Brülle AL, Wu C, Rasch V, Simonsen MK, Schøyen IS, Dahl C, Nohr EA. How do reproductive history and anthropometry in midlife relate to later risk of pelvic organ prolapse? A prospective cohort study. Int Urogynecol J 2022; 33:3373-3380. [PMID: 35254470 DOI: 10.1007/s00192-022-05122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine the association between reproductive and anthropometric factors and later risk of pelvic organ prolapse (POP). METHODS We carried out a prospective cohort study including 11,114 female nurses > 44 years from the Danish Nurse Cohort. In 1993, the study population was recruited through the Danish Nurse Organization and self-reported data on age, height, weight, age at menarche, age at first birth and number of childbirths were obtained. POP diagnosis was obtained from the National Patient Registry. Risk of POP was estimated using COX regression and presented as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Overall, 10% of the women received a diagnosis of POP within a median follow-up of 22 years. A 4% increase in risk of POP was seen for each increasing BMI (kg/m2) unit at baseline. Compared to women of normal weight, higher risks of POP were seen in overweight (HR 1.18: 1.02-1.36) and obese women (HR 1.33: 1.02-1.74), while underweight had a lower risk (HR 0.51: 0.27-0.95). Compared to women with one childbirth, women with no childbirths had a reduced risk of 57% while increased risks of 46%, 78% and 137% were observed in women with two, three and four childbirths. Women with menarche before the age of 12 tended to have a higher risk of POP as did women who were 30-33 years at their first childbirth. CONCLUSIONS POP is a common health problem in women, and BMI and number of childbirths are strong predictors.
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Affiliation(s)
- Anne-Line Brülle
- Occupational and Environmental Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Chunsen Wu
- Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark
| | - Vibeke Rasch
- Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark
| | - Mette Kildevæld Simonsen
- Department of Neurology and Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ine Schmidt Schøyen
- Department of Gynaecology and Obstetrics, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Carina Dahl
- Department of Paediatrics, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Ellen Aagaard Nohr
- Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark
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Verhorstert K, Gudde A, Weitsz C, Bezuidenhout D, Roovers JP, Guler Z. Absorbable Electrospun Poly-4-hydroxybutyrate Scaffolds as a Potential Solution for Pelvic Organ Prolapse Surgery. ACS APPLIED BIO MATERIALS 2022; 5:5270-5280. [PMID: 36315937 PMCID: PMC9682484 DOI: 10.1021/acsabm.2c00691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Women with pelvic organ prolapse (POP) have bothersome complaints that significantly affect their quality of life. While native tissue repair is associated with high recurrence rates, polypropylene knitted implants have caused specific implant-related adverse events that have detrimental, often irreversible, effects. We hypothesize that surgical outcome can be improved with a tissue-engineered solution using an absorbable implant that mimics the natural extracellular matrix (ECM) structure, releases estrogen, and activates collagen metabolism by fibroblasts as the main regulators of wound healing. To this aim, we produced electrospun poly-4-hydroxybutyrate (P4HB) scaffolds and biofunctionalized them with estradiol (E2). The cell-implant interactions relevant for POP repair were assessed by seeding primary POP vaginal fibroblasts isolated from patients on electrospun P4HB scaffolds with 1%, 2%, or 5% E2 and without E2. To test our hypothesis on whether ECM mimicking structures should improve regeneration, electrospun P4HB was compared to knitted P4HB implants. We evaluated vaginal fibroblast proliferation, ECM deposition, and metabolism by quantification of collagen, elastin, and matrix metalloproteinases and by gene expression analysis for 28 days. We established effective E2 drug loading with a steady release over time. Significantly higher cell proliferation, collagen-, and elastin deposition were observed on electrospun P4HB scaffolds as compared to knitted P4HB. For this study, physical properties of the scaffolds were more determinant on the cell response than the release of E2. These results indicate that making these electrospun P4HB scaffolds E2-releasing appears to be technically feasible. In addition, electrospun P4HB scaffolds promote the cellular response of vaginal fibroblasts and further studies are merited to assess if their use results in improved surgical outcomes in case of POP repair.
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Affiliation(s)
- Kim Verhorstert
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Aksel Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Carmen Weitsz
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Deon Bezuidenhout
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Jan-Paul Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,
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Vargas Maldonado D, Madsen AM. Vaginal symptoms in women who are affected by gynecologic cancer. Curr Opin Obstet Gynecol 2021; 33:474-482. [PMID: 34494971 DOI: 10.1097/gco.0000000000000743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Pelvic floor disorders are common among gynecologic cancer survivors. With improvements in survivorship, quality of life conditions in these women need greater attention and care. This review focuses specifically on vulvovaginal symptoms, which are common and have a negative impact on sexual health and quality of life in women affected by gynecologic cancer. RECENT FINDINGS We review publications on treatment-specific sexual health outcomes, screening and treatment of vulvovaginal symptoms and sexual pain, and surgical management options. Recent evidence regarding the safety of concomitant prolapse repair at the time of surgery for gynecologic malignancies and CO2 laser therapy is discussed and areas needing further research and innovation are highlighted. SUMMARY Pelvic floor disorders, including vaginal and sexual health concerns, are common in women affected by gynecologic cancer due to both common risk factors and as a side effects of cancer treatment. Gynecologists play a critical role in screening, treatment, and collaboration with other specialists to provide comprehensive care for these women throughout their lifetime.
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Affiliation(s)
- Darlene Vargas Maldonado
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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