Tissue Composition of the Vaginal Wall in Women with Pelvic Organ Prolapse

Objective: The aim of this study was to evaluate the expression of cyclooxygenase 2 (COX-2) and its association with the development of premalignant lesions in gland structures of the endometrium in patients with uterine prolapse, a condition which exposes the uterus to mechanical and infectious stress. Methods: The study included 102 patients who underwent hysterectomy to correct grade 3-4 uterine prolapse and 105 patients who underwent hysterectomy for other causes. Endometrial gland structures underwent immunohistochemical staining and COX-2 expression was graded. Grades 0 and 1 represent low expression; grades 2 and 3 correspond to high levels of COX-2 expression. Results: The prevalence of grade 2-3 COX-2 expression was significantly higher in the endometrial gland structures of patients with prolapse and hyperplasia compared to the remaining patients (p = 0.014). Grade 0-1 COX-2 expression was significantly more common in the endometrial gland structures of patients without uterine prolapse or hyperplasia (p = 0.004). Among the patients without endometrial hyperplasia, COX-2 expression was elevated in the endometrial gland structures of those with uterine prolapse compared to those without prolapse. Conclusion: Elevated COX-2 expression may explain the presence of unexpected premalignant lesions of the endometrium in patients with uterine prolapse.

Section: Introductionmentioning

confidence: 99%

Does Uterine Prolapse Alter Endometrial Cyclooxygenase 2 Expression and Promote the Development of Premalignant Lesions?

Genç¹,

Sivrikoz²,

Şahin³

et al. 2015

“…Pelvic organ prolapse is a multifactorial disorder and the vaginal wall of concerned patients is often described as weakened or altered [1,2]. These pelvic floor disorders are treated either with noninvasive methods such as pelvic floor exercises or pessary therapy, or with classical surgical methods such as vaginal sacrospinous fixation, abdominal sacrocolpopexy, or Burch colposuspension [3,4].…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair

Brocker¹,

Lippus

Alt

et al. 2014

Aim: To develop a magnetic resonance (MR)-visible mesh using iron oxides and prove visibility. Methods: In a phantom study, a suitable iron oxide, Fe₃O₄ [iron(II,III) oxide] and FeOOH [iron(III) oxide-hydroxide], concentration was determined using relaxometric MR measurements of the transverse relaxation rates R2 and R2*. Next, a nonabsorbable mesh was designed from the MR-visible threads woven into a polypropylene mesh. The mesh was implanted into a fresh female cadaver via the transobturator route, and MR visibility was assessed with various MR pulse sequences in a clinical 3-tesla system. Results: Optimal contrast was achieved with Fe₃O₄ at 0.2 weight-% in all imaging sequences, and the optimal contrast was achieved in a 3D spoiled gradient-echo (fast low-angle shot) acquisition. In this concentration range the apparent transverse relaxation rate R2* is below 10 ms. The mesh was visible in the cadaver on T1-weighted 3D spoiled gradient-echo images and T1-weighted fast spin-echo images. Conclusion: Mesh materials can be manufactured to be visible on MR with a negative contrast. Fe₃O₄ meshes could simplify follow-up examinations and help diagnose origins of postsurgical lesions after urogynecological procedures with mesh material.

“…It is estimated that annual POP surgeries involve an expenditure of over USD 1 billion [2]. The etiologies of POP have been extensively reviewed [5,6,7,8], and current evidence suggests an important etiology of POP is the degradation of collagen in vaginal tissues [9,10]. Interestingly, strengthening collagen fibers by cross-linking in collagen types I, III and V has been achieved using combined riboflavin UVA (365-370 nm) photoactivation treatment in corneal repairs [11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

UVA-Photoactivated Riboflavin Treatment of Vaginal Cells Derived from Pelvic Organ Prolapse Cases

Schultz

Siddighi²,

Hardesty³

et al. 2014

Background: The pathophysiology of pelvic organ prolapse (POP) involves vaginal collagen degradation. Strengthening collagen by UVA-photoactivated cross-linking has been demonstrated and suggested target applications include the vaginal wall. Aim: To identify UVA irradiation and riboflavin effects on vaginal cells. Materials and Methods: Vaginal cells were incubated for 24 h (DMEM/F-12 Ham's media) and were exposed to riboflavin (0, 0.1 and 10%) for 30 min before UVA photoactivation. Percentages of live, apoptotic and necrotic cells were determined by propidium iodide/Hoechst 33342 stains. Results: UVA decreased vaginal cell viability [mean ± standard error of the mean: 26.2 ± 0.5% vs. control (43.9 ± 3.8%)], but riboflavin blocked UVA-induced damage (57.9 ± 2.7 and 56.7 ± 2.1% at 0.1 and 10% riboflavin, respectively). Cells treated with low- and high-dose riboflavin had lower apoptosis (32.9 ± 1.0 and 35.5 ± 0.9%, respectively). Furthermore, riboflavin-treated cells had reduced necrosis (9.3 ± 1.7, 7.8 ± 3.0%) versus UVA-only (32.4 ± 5.5%) or control (17.1 ± 2.8%). Viability was similar for cells from the cervical and hymenal segments. Conclusion: The results demonstrated that riboflavin attenuated UVA damage in vaginal cells by inhibiting necrosis. Cervical and hymenal end vaginal cells were equally affected by UVA. UVA phototoxicity was reduced by the presence of riboflavin.