Comparison between Baden and Walker classification systems and ICS standardization of terminology of female pelvic organ prolapse

OBJECTIVE: to compare Baden and Walker's (BW) classification system to the International Continence Society (ICS) standardization of terminology of female pelvic organ prolapse. METHODS: information about urogynecological investigation on 101 women, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, was retrospectively analyzed. Only patients who had undergone the standard ICS exam which quantifies the pelvic prolapse were selected. According to ICS, the prolapse is analyzed through a standard reference system relating the hymen to the anatomic position of six vaginal points: two in the anterior vaginal wall, two in the vaginal apex and other two in the posterior vaginal wall. The maximum amount of pelvic organ prolapse was viewed and recorded during a Valsalva's maneuver. The measurement of the most distal point of the prolapse was performed and it was compared to the BW classification system. The data were analyzed by kappa statistics, to assess the concordance between the two terminologies. RESULTS: There was total correspondence only for the posterior vaginal prolapse stage IV (one patient) and for the uterus prolapse stage 0 (29 patients) with severe rectocele and absence of prolapse, respectively, according to BW. In the three types of prolapses evaluated, the values of kappa statistics were below 0.4, indicating a weak concordance between the two terminologies. There is an extensive variation in the measurement of the most distal point of prolapse when the BW classification is perfomed. CONCLUSIONS: there is a weak concordance between the BW classification system and the ICS standardization of terminology of female pelvic organ prolapse.OBJETIVO: comparar a classificação de Baden e Walker (BW) para o prolapso pélvico feminino e a preconizada pela Sociedade Internacional de Continência (ICS). MÉTODOS: em trabalho retrospectivo foram analisadas as informações sobre 101 pacientes atendidas no setor de Uroginecologia e Cirurgia Vaginal do Departamento de Ginecologia da UNIFESP/EPM durante investigação uroginecológica. As pacientes foram selecionadas a partir da revisão do prontuário médico, onde foram identificadas aquelas que submeteram-se a exame padronizado pela ICS a fim de quantificar o prolapso pélvico feminino. Conforme preconiza a ICS, o prolapso foi analisado por um sistema padrão de referência que relaciona a carúncula himenal (ponto fixo) à posição anatômica de seis pontos definidos: 2 na parede vaginal anterior, 2 no ápice vaginal e 2 na parede vaginal posterior. A máxima protrusão do prolapso foi visualizada e registrada durante a manobra de Valsalva solicitada à paciente. Realizou-se a medida do ponto mais externo do prolapso (pontos Ba, Bp e C) comparando-o com a classificação de BW. A medida adotada para avaliar a concordância entre as duas terminologias foi a estatística kappa. RESULTADOS: observou-se correspondência de 100% somente para o prolapso de parede vaginal posterior estádio IV (1 paciente) e para o prolapso uterino estádio zero (29 pacientes), segundo Baden e Walker, com retocele severa e ausência de prolapso, respectivamente. Para os três tipos de prolapsos examinados, os valores da estatística kappa estavam abaixo de 0,4, indicando fraca concordância entre as duas terminologias. Concluímos que existe uma ampla variação nas medidas do ponto mais externo do prolapso ao se realizar a classificação de BW. Para um determinado grau de prolapso na classificação de BW encontramos mais de um estádio na classificação da ICS. CONCLUSÕES: existe fraca concordância entre as classificações de Baden e Walker e a da Sociedade Internacional de Continência para as distopias genitais.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GinecologiaUNIFESP, EPM, Depto. de GinecologiaSciEL

The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: a randomized controlled trial

The aim of the study was to compare the efficacy and safety of transvaginal trocar-guided polypropylene mesh insertion with traditional colporrhaphy for treatment of anterior vaginal wall prolapse.This is a randomized controlled trial in which women with advanced anterior vaginal wall prolapse, at least stage II with Ba a parts per thousand yenaEuro parts per thousand+1 cm according to the Pelvic Organ Prolapse Quantification (POP-Q) classification, were randomly assigned to have either anterior colporrhaphy (n = 39) or repair using trocar-guided transvaginal mesh (n = 40). the primary outcome was objective cure rate of the anterior compartment (point Ba) assessed at the 12-month follow-up visit, with stages 0 and I defined as anatomical success. Secondary outcomes included quantification of other vaginal compartments (POP-Q points), comparison of quality of life by the prolapse quality of life (P-QOL) questionnaire, and complication rate between the groups after 1 year. Study power was fixed as 80 % with 5 % cutoff point (p 0.05).Trocar-guided transvaginal synthetic mesh for advanced anterior POP repair is associated with a higher anatomical success rate for the anterior compartment compared with traditional colporrhaphy. Quality of life equally improved after both techniques. However, the trial failed to detect differences in P-QOL scores and complication rates between the groups.Universidade Federal de São Paulo, Sect Urogynecol & Vaginal Surg, Dept Gynecol, BR-04534000 São Paulo, BrazilUniversidade Federal de São Paulo, Sect Urogynecol & Vaginal Surg, Dept Gynecol, BR-04534000 São Paulo, BrazilWeb of Scienc

Influence of estrogen deprivation in lower urinary tract expression genes of ovariectomized and non-ovariectomized adult rats

Introdução: A acao dos hormonios estrogenios nos tecidos urogenitais ja foi amplamente estudada e comprovada pelos achados de receptores de estrogenio na bexiga, uretra e musculatura do assoalho pelvico, bem como a associacao do hipoestrogenismo com sintomas e afeccoes uroginecologicas tao comuns em mulheres na pos-menopausa: incontinencia urinaria de esforco, incontinencia de urgencia, urgencia miccional, polaciuria e miccoes em intervalos curtos e infeccoes urinarias. No entanto, a literatura e escassa em relacionar os estrogenios e a defiCiência deste hormonio com os mecanismos de controle celular atraves da molecula de DNA e dos genes do trato urinario inferior, responsaveis pela producao das proteinas necessarias para o funcionamento do trato urinario. Objetivo: Identificar a influencia do hipoestrogenismo na expressao diferencial de genes do trato urinario inferior de ratas adultas. Material e Metodos: Utilizamos 50 ratas adultas isogenicas que foram distribuidas aleatoriamente em dois grupos de 25 animais: grupo I, ratas ooforectomizadas trinta dias antes da extracao de suas bexigas e uretras; grupo li, ratas nao ooforectomizadas, das quais foram extraidos os orgaos do trato urinario inferior. A partir de um pool de RNA total isolado das bexigas e uretras dos animais, a expressao genica diferencial entre os grupos foi analisada quantitativa, qualitativa e comparativamente pela tecnologia de cDNA microarray. Resultados: Um total de 76 genes foi identificados como diferencialmente expressos entre os grupos, sendo 26 genes superexpressos no grupo I, e 50 genes superexpressos no grupo II. Dentre eles, confirmamos por RT-PCR a expressao diferencial de 3 genes superexpressos no grupo de ratas nao ooforectomizadas: VEGF, Beta-2 Microglobulina e Citocromo c Oxidase subunidade I. Estes genes estao envolvidos em atividades de: angiogenese, como fator de crescimento vasculo-endotelial; resposta imunologica, como componente dos antigenos HLA ; metabolismo celular, como componente do complexo de respiracao celular, respectivamente. Conclusoes: A tecnologia de cDNA microarray e um importante metodo de screening genico no estudo da acao do estrogenio no trato urinario inferior. O periodo de trinta dias de deprivacao estrogenica fez diminuir a expressao dos genes VEGF, Beta-2 Microglobulina e Citocromo c Oxidase subunidade I em ratas adultas castradas. Acreditamos estar a menor expressao dos genes VEGF, B2M e COX I associada, pelo menos em parte, com o desenvolvimento de disturbios uroginecologicos, respectivamente, a incontinencia urinaria de esforco, infeccoes do trato urinario e defiCiência contratil da musculatura detrusora em mulheres na pos-menopausaBV UNIFESP: Teses e dissertaçõe

Genetics of pelvic organ prolapse: crossing the bridge between bench and bedside in urogynecologic research

An increasing number of scientists have studied the molecular and biochemical basis of pelvic organ prolapse (POP). the extracellular matrix content of the pelvic floor is the major focus of those investigations and pointed for potential molecular markers of the dysfunction. the identification of women predisposed to develop POP would help in the patients' management and care. This article includes a critical analysis of the literature up to now; discusses implications for future research and the role of the genetics in POP.Universidade Federal de São Paulo, Dept Gynecol, Div Urogynecol & Reconstruct Pelv Surg, BR-04038031 São Paulo, BrazilAin Shams Univ, Fac Med, Dept Obstet & Gynecol, Cairo, EgyptUniversidade Federal de São Paulo, Dept Gynecol, Div Urogynecol & Reconstruct Pelv Surg, BR-04038031 São Paulo, BrazilWeb of Scienc

Pelvic floor symptoms 5 to 14years after total versus subtotal hysterectomy for benign conditions: a systematic review and meta-analysis

Introduction and hypothesisWe aim to compare total versus subtotal abdominal hysterectomy regarding urinary and bowel symptoms and pelvic organ prolapse at long-term follow-up.MethodsA systematic literature search was performed on the MEDLINE, LILACS, Cochrane CENTRAL and SCOPUS databases and conference abstracts (AAGL, AUGS, ICS) from inception up to November 2017. We included randomized trials comparing total versus subtotal hysterectomy for benign conditions that evaluated pelvic floor symptoms over 5years of follow-up. Risk of bias and GRADE assessment for quality of evidence were performed.ResultsWe included four studies involving 566 participants with follow-up ranging from 5 to 14years. Women who underwent total hysterectomy presented lower risk of reported urinary incontinence [RR 0.74 (CI=0.58, 0.94) i(2) 0%; p=0.02] and stress urinary incontinence [RR 0.84 (CI=0.71, 0.99) i(2) 0%; p=0.04] than those who had subtotal hysterectomy. The events urinary frequency, urge incontinence, incomplete bladder emptying, pelvic organ prolapse, incontinence of stool and constipation did not favor one procedure over another in the long term (P>0.05).ConclusionsPatient-reported urinary incontinence and stress urinary incontinence events favored total hysterectomy over subtotal hysterectomy up to 14-year long-term follow-up302181191sem informaçãosem informaçã

Outpatient biofeedback in addition to home pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial

AIMSTo test if biofeedback (BF) added to pelvic floor muscle training (PFMT) increases the frequency of home exercises performed by women with stress urinary incontinence (SUI). METHODS72 incontinent women were randomized to BF (outpatient BF+home PFMT) or PFMT (outpatient PFMT+home PFMT) groups. Assessments: baseline, after 3 months of supervised treatment, at 9-month follow-up (after six additional months of home PFMT only). Primary outcome: frequency of monthly exercises sets performed (exercise diary) after 3-month treatment. Secondary outcomes: adherence, urinary symptoms, severity and cure of SUI (pad test<2g leakage), muscle function, quality of life, and subject cure (satisfaction report with no desire for different treatment) at the two time-points. Statistical analyses: ANOVA and Student's t-test with 5% cut-off for significance. RESULTSIt was observed similar frequency of monthly home exercises sets performed by BF (67.9 out of 82) and PFMT (68.2 out of 82) groups at 3 months. Secondarily, equal satisfaction, but superior objective cure of SUI for BF group after 3-month treatment (P=0.018; OR: 3.15 [95% CI: 1.20-8.25]). At 9-month follow-up, the adherence to home exercises was similar (around 50%) and significantly dropped in both groups compared to the 3-month results (around 85%). No difference was detected in the objective and subjective cure of SUI between the groups after 9 months. Both therapies similarly improved the muscle function and quality of life during the study (P<0.005). CONCLUSIONSAdjunct BF did not increase the frequency of home exercises performed by SUI patients.National Council for Scientific and Technological Development (CNPq) Research FoundationUniv Fed Sao Paulo, Dept Gynaecol, Rua Napoleao de Barros,608 Vila Clementino, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynaecol, Rua Napoleao de Barros,608 Vila Clementino, BR-04024002 Sao Paulo, SP, BrazilCNPq: 140190/2013-9Web of Scienc

Collagen XVIII and LOXL-4 polymorphisms in women with and without advanced pelvic organ prolapse

Introduction and hypothesis We verified the presence of single nucleotide polymorphisms (SNP) rs2236479 of the collagen 18 (COL18A1) and rs2862296 of the lysyl oxidase-like 4 (LOXL-4) genes and the association with pelvic organ prolapse (POP) in Brazilian women and determined risk factors for POP development. Methods We assessed 532 postmenopausal women divided into POP (stages III and IV) and control (stages 0 and I) groups by examination and peripheral blood sample collection. DNA sequences of interest were analyzed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). We used logistic regression models for the analyses, with p < 0.005 for significance. Results The frequency of homozygous polymorphic alleles (AA) in COL18A1 and (GG) in LOXL-4 were similar in both groups (17.5% and 15.4% for COL18A1 and 18.9% and 20.6% for LOXL-4, respectively). There were no associations between those polymorphisms or other genotypes and POP. Multiple logistic regression analysis identified age [odds ratio (OR) = 1.10, confidence interval (CI) 95% = 1.071.14), number of vaginal births (OR = 1.66, CI 95% = 1.362.03), and family history (OR = 2.55 CI 95% = 1.434.55) as independent risk factors for POP. Conclusion Our study suggests lack of association between DNA polymorphisms rs2236479 of COL18A1 and rs2862296 of LOXL-4 with advanced POP in this population.Univ Fed Sao Paulo, Dept Gynecol, Div Urogynecol & Reconstruct Pelv Surg, Rua Rodolfo Belz 220-42A, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol, Div Mol Biol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Gynecol, Div Urogynecol & Reconstruct Pelv Surg, Rua Rodolfo Belz 220-42A, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol, Div Mol Biol, Sao Paulo, BrazilWeb of Scienc