The TVT procedure for the management of stress urinary incontinence in women maintains its efficacy in the long term, having an objective cure rate of 83.9% and a subjective cure rate of 78.6% at 17 years' follow-up, with a very low complications rate.
To assess the long‐term outcomes of tension‐free vaginal tape obturator (inside‐out) (TVTO) with or without anterior colporrhaphy.
The present prospective follow‐up observational study included patients attending the 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece, between April 3 and December 20, 2017, for follow‐up care after treatment for urodynamic stress urinary incontinence (USUI) with or without cystocele. Patients without cystocele had been treated with TVTO only; those with cystocele underwent TVTO with anterior colporrhaphy. The primary outcome was the objective cure rate assessed by the cough stress test during filling cystometry.
Follow‐up data were available for 70 patients who underwent TVTO only and 38 who underwent TVTO and anterior colporrhaphy. The mean follow‐up period was 13 years. Objective cure was achieved for 57 (81%) patients in the TVTO‐only group and 32 (84%) patients in the TVTO and anterior colporrhaphy group. Regarding cystocele management, objective cure was recorded for 35 (92%) patients.
At 13‐year follow‐up, anterior colporrhaphy demonstrated a cure rate of 92% in the management of cystocele, and 84% in the management of cystocele and USUI when combined with TVTO. TVTO alone for the management of USUI had an objective cure rate of 81%.
Clinicians should be aware about the importance of carefully examining not only the cervix at the time of labor, but also the episiotomy scar in women following a pregnancy complicated by cervical cancer.
Pelvic organ prolapse (POP) is a common multifactorial condition. Matrix metalloproteinases (MMPs) are enzymes capable of breaking down various connective tissue elements. Single-nucleotide polymorphisms (SNPs) in regulatory areas of MMP-encoding genes can alter their transcription rate, and therefore the possible effect on pelvic floor supporting structures. The insertion of an adenine (A) base in the promoter of the MMP-3 gene at position −1612/−1617 produces a sequence of six adenines (6A), whereas the other allele has five (5A). The aim of the present study was to investigate the possible association of MMP-3 gene promoter SNPs with the risk of POP. The patient group comprised 80 women with clinically significant POP [Stage II, III or IV; POP quantification (POP-Q) system]. The control group consisted of 80 females without any or important pelvic floor support defects (Stages 0 or I; POP-Q system). All the participants underwent the same preoperative evaluation. SNP detection was determined with whole blood sample DNA analysis by quantitative polymerase chain reaction (PCR) in LightCycler® PCR platforms, using the technique of sequence-specific hybridization probe-binding assays and melting temperature curve analysis. The results showed there was no statistically significant difference between 5A/5A, 5A/6A and 6A/6A MMP-3 gene promoter variants in the two study groups (P=0.4758). Therefore, MMP-3 gene promoter SNPs alone is insufficient to increase the genetic susceptibility to POP development.
Postpartum nephrotic syndrome in a pregnant woman with rheumatoid arthritis in long-standing remission is rare. Systemic lupus erythematosus can remain undiagnosed, especially in the absence of clinical manifestations. We present the case of a 34-year-old woman (gravida 2, para 1) who underwent a lower-segment cesarean section at 34 weeks and 6 days of gestation because she had developed preeclampsia and nephrotic syndrome. The concomitant presence of significant hypoproteinemia, hypoalbuminemia, uremia, elevated creatinine serum levels, hyperuricemia and hypertriglyceridemia is indicative of impaired renal function and nephrotic syndrome. This woman was diagnosed with systemic lupus erythematosus nephritis. It is imperative for clinicians to investigate the exact pathophysiological causes of nephrotic syndrome with onset in the puerperium and implement the appropriate therapeutic regimens.
Η πρόπτωση πυελικών οργάνων (ΠΠΟ) αποτελεί μία συχνή πολυπαραγοντική κατάσταση. Οι μεταλλοπρωτεϊνάσες της εξωκυττάριας θεμέλιας ουσίας (Matrix Metalloproteinases, MMPs) συγκροτούν οικογένεια ενζύμων που διασπούν το συνδετικό ιστό. Μονονουκλεοτιδικοί πολυμορφισμοί (Single Nucleotide Polymorphisms, SNPs) σε ρυθμιστικές περιοχές γονιδίων που κωδικοποιούν MMPs μπορούν να μεταβάλουν το ρυθμό μεταγραφής των γονιδίων αυτών, αλλάζοντας έτσι την επίδραση των MMPs στις πυελικές δομές. Η εισαγωγή ενός νουκλεοτιδίου αδενίνης (Α) στη θέση -1612/-1617 του υποκινητή του γονιδίου που κωδικοποιεί την MMP-3 παράγει το αλληλόμορφο 6Α, ενώ το άλλο αλληλόμορφο είναι 5Α. Σκοπός της παρούσας διατριβής είναι η διερεύνηση της συσχέτισης των SNPs της MMP-3 με τον κίνδυνο εμφάνισης ΠΠΟ στον ελληνικό πληθυσμό. Το δείγμα της μελέτης αποτελείται από 80 Ελληνίδες με ΠΠΟ και 80 Ελληνίδες χωρίς ΠΠΟ. Η ανίχνευση των SNPs έγινε στο DNA που ελήφθη από το αίμα των συμμετεχουσών και αναλύθηκε μέσω θερμής εκκίνησης πραγματικού χρόνου Αλυσιδωτής Αντίδρασης Πολυμεράσης (hot-start real-time Polymerase Chain Reaction, PCR) και συστοιχιών που προσδένονται σε ένα φθορίζοντα ανιχνευτή υβριδισμού συγκεκριμένης αλληλουχίας (sequence–specific hybridization probe binding assays). Η εργαστηριακή και η στατιστική επεξεργασία των δειγμάτων κατέληξε στην απουσία διαφοράς μεταξύ των δiαφόρων SNPs της MMP-3 και της παρουσίας ή μη ΠΠΟ. Συμπερασματικά, η αποκλειστική επίδραση των SNPs στον υποκινητή του γονιδίου που κωδικοποιεί την MMP-3 δεν αρκεί για να θεμελιώσει τη γενετική προδιάθεση για ανάπτυξη ΠΠΟ.
Background and aim: Thousands of women worldwide suffer from pelvic organ prolapse and stress urinary incontinence. Low quality of pelvic connective tissue contributes to the development of the above conditions. Previous studies suggest that relaxin reduces the tensile strength of pelvic connective tissue. The aim of this study was to assess the presence of relaxin in uterine supporting tissues from patients with pelvic organ prolapse and stress urinary continence.
Methods:We recruited 90 women: 30 patients with pelvic organ prolapse and stress urinary incontinence, 30 continent women with pelvic organ prolapse and 30 controls. Tissue samples from the participants were obtained from the insertion sites of the uterosacral and cardinal ligaments at the time of hysterectomy. Immunostaining defined relaxin expression intensity.Results: There are statistically significant differences regarding the intensity of relaxin expression between women with pelvic organ prolapse plus stress urinary incontinence and continent women with or without pelvic organ prolapse, as well as between women with prolapse plus incontinence and controls (P<0.05). Continent women with prolapse and controls were more likely to have negative relaxin expression than incontinent women with prolapse. Not any statistically significant differences were found between women with both prolapse and incontinence and women with prolapse only, as well as between continent women with prolapse and controls. Incontinent patients with prolapse had a higher probability of having positive relaxin expression than controls. No women with prolapse and only one control had strongly positive relaxin expression.
Conclusions:Positive relaxin expression in pelvic connective tissue could be a predisposing factor for pelvic organ prolapse and/or stress urinary incontinence. Possible future interventions based on relaxin expression may aid in the non-surgical management of pelvic organ prolapse and stress urinary incontinence.
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