Does the vaginal wall become thinner as prolapse grade increases?

Bray, Rhiannon; Derpapas, Alex; Fernando, Ruwan; Khullar, Vik; Panayi, Demetri

doi:10.1007/s00192-016-3150-1

Cited by 15 publications

(5 citation statements)

References 29 publications

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“…Anterior vaginal prolapse (AVP) is the most frequently occurring form of POP. Recently, some studies have reported that the thickness, mechanical properties and structural composition of the vaginal wall are altered in women with POP 7 , 8 . Weakness of the vaginal wall is considered to be a possible cause of prolapse.…”

Section: Introductionmentioning

confidence: 99%

Single-cell transcriptome profiling of the vaginal wall in women with severe anterior vaginal prolapse

Zhang

Sun

et al. 2021

Nat Commun

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Anterior vaginal prolapse (AVP) is the most common form of pelvic organ prolapse (POP) and has deleterious effects on women’s health. Despite recent advances in AVP diagnosis and treatment, a cell atlas of the vaginal wall in AVP has not been constructed. Here, we employ single-cell RNA-seq to construct a transcriptomic atlas of 81,026 individual cells in the vaginal wall from AVP and control samples and identify 11 cell types. We reveal aberrant gene expression in diverse cell types in AVP. Extracellular matrix (ECM) dysregulation and immune reactions involvement are identified in both non-immune and immune cell types. In addition, we find that several transcription factors associated with ECM and immune regulation are activated in AVP. Furthermore, we reveal dysregulated cell–cell communication patterns in AVP. Taken together, this work provides a valuable resource for deciphering the cellular heterogeneity and the molecular mechanisms underlying severe AVP.

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Section: Introductionmentioning

confidence: 99%

Single-cell transcriptome profiling of the vaginal wall in women with severe anterior vaginal prolapse

Zhang

Sun

et al. 2021

Nat Commun

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“…The vaginal wall is only a few mm thick, 2.5-3.5 mm in one series where measurement was by ultrasound. 16 One study denied the MV was thinner in the presence of POP 17 though another series shows a thinning from POP Stage I to II, then and an increase in thickness to Stage III. 16 This is however strong.…”

Section: Histology Of the MVmentioning

confidence: 99%

“…16 One study denied the MV was thinner in the presence of POP 17 though another series shows a thinning from POP Stage I to II, then and an increase in thickness to Stage III. 16 This is however strong. The combined muscularis and adventitia layers can support an additional layer of plicatory sutures during anterior colporrhaphy.…”

Section: Histology Of the MVmentioning

confidence: 99%

Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

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Aim The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (POP). Methods Literature review and surgical observations of many aspects of the MV were performed including MV length and width; MV shape; immediate relationships; histological analysis; anterior and posterior MV prolapse assessment and anterior MV surgical aspects. Unpublished pre‐ and postoperative quantitative data on 300 women undergoing posterior vaginal compartment repairs are presented. Results The MV runs from the lower limit of the vaginal vault (VV) to the hymen. Its length is a mean of 5 cm. Its shape in section overall is a compressed rectangle. Its longitudinal shape is created by its anterior and posterior walls being inverse trapezoid in shape. Histology comprises three layers: (i) mucosa; (ii) muscularis; (iii) adventitia. MV prolapse staging uses pelvic organ prolapse quantification (POP‐Q). Anterior MV prolapse can be quantitatively assessed using POP‐Q while posterior MV prolapse can be assessed with POP‐Q or PR‐Q. Around 50% of both cystocele and rectocele are due to VV defects. POP will increase anterior MV width and length. Native tissue anterior colporrhaphy is the current conventional repair with mesh disadvantages outweighing advantages. Posteriorly, Level II (MV) defects are far smaller (mean 1.3 cm) than Level I (mean 6.0 cm) and Level III (mean 2.9 cm). Conclusion An understanding of the surgical anatomy of the MV can assist anterior and posterior colporrhaphy. In particular, if VV support is employed, the Level II component of a posterior repair should be relatively small.

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“…It is collagen, organized into fibers and bundles, that normally provides tensile strength to tissues. It has previously been demonstrated that vaginal wall thickness decreases in women with prolapse, and this may be due to changes in the collagen bundles [10]. Histological changes in pelvic floor tissue showed that collagen fibrils lost their native well-organized, tightly packed morphology and acquired loose, disorderly and discontinuous structures [11].…”

Section: Introductionmentioning

confidence: 99%

Depth-Resolved Attenuation Mapping of the Vaginal Wall under Prolapse and after Laser Treatment Using Cross-Polarization Optical Coherence Tomography: A Pilot Study

Gubarkova,

Potapov,

Moiseev

et al. 2023

Diagnostics

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Vaginal wall prolapse is the most common type of pelvic organ prolapse and is mainly associated with collagen bundle changes in the lamina propria. Neodymium (Nd:YAG) laser treatment was used as an innovative, minimally invasive and non-ablative procedure for the treatment of early-stage vaginal wall prolapse. The purpose of this pilot study was to assess connective tissue changes in the vaginal wall under prolapse without treatment and after Nd:YAG laser treatment using cross-polarization optical coherence tomography (CP OCT) with depth-resolved attenuation mapping. A total of 26 freshly excised samples of vaginal wall from 26 patients with age norm (n = 8), stage I–II prolapses without treatment (n = 8) and stage I–II prolapse 1–2 months after Nd:YAG laser treatment (n = 10) were assessed. As a result, for the first time, depth-resolved attenuation maps of the vaginal wall in the B-scan projection in the co- and cross-polarization channels were constructed. Two parameters within the lamina propria were target calculated: the median value and the percentages of high (≥4 mm−1) and low (<4 mm−1) attenuation coefficient values. A significant (p < 0.0001) decrease in the parameters in the case of vaginal wall prolapse compared to the age norm was identified. After laser treatment, a significant (p < 0.0001) increase in the parameters compared to the normal level was also observed. Notably, in the cross-channel, both parameters showed a greater difference between the groups than in the co-channel. Therefore, using the cross-channel achieved more reliable differentiation between the groups. To conclude, attenuation coefficient maps allow visualization and quantification of changes in the condition of the connective tissue of the vaginal wall. In the future, CP OCT could be used for in vivo detection of early-stage vaginal wall prolapse and for monitoring the effectiveness of treatment.

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Does the vaginal wall become thinner as prolapse grade increases?

Cited by 15 publications

References 29 publications

Single-cell transcriptome profiling of the vaginal wall in women with severe anterior vaginal prolapse

Single-cell transcriptome profiling of the vaginal wall in women with severe anterior vaginal prolapse

Surgical anatomy of the mid‐vagina

Depth-Resolved Attenuation Mapping of the Vaginal Wall under Prolapse and after Laser Treatment Using Cross-Polarization Optical Coherence Tomography: A Pilot Study

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