Search

Objective: Pelvic organ prolapse (POP) is a common health issue that has a profound negative influence on women's quality of life. Genetic susceptibility to POP has been increasingly investigated. In this study, we assessed the single-nucleotide polymorphisms (SNPs) of six collagen-related genes (COL14A1, COL5A1, COL4A2, COL3A1, COL1A1, and COL18A1) and the genetic association with POP in Chinese women. Methods: We performed a candidate gene association study of case women (n = 48) with stage III and IV prolapse and control women (n = 48) without prolapse. A target region sequencing approach was used to identify the SNPs in collagen-related genes. The association between SNPs and POP was examined by Fisher exact tests for unadjusted model and logistic regression analysis adjusted for delivery and pregnancy. Results: There was a significant association between COL14A1 SNPs (rs4870723, rs2305600, and rs2305598; P = 0.013, 0.019, and 0.028, respectively), a COL5A1 SNP (rs3827852; P = 0.016), and COL4A2 SNPs (rs76425569, rs388222, and rs2281968; P = 0.049 for the three, and rs445348, P = 0.040) and POP, respectively. Although there was no significant association between the COL3A1 SNP and POP, there was a trend toward significance for COL14A1 SNP (rs2305603), COL4A2 SNP (rs74941798), two COL1A1 SNPs (rs2586488 and rs2249492) and three COL18A1 SNPs (rs1050351, rs56335679, and rs55690336), and POP. Conclusion: We are the first to evaluate the relationship between COL14A1, COL5A1, and COL4A2 polymorphisms and POP, besides COL3A1, COL1A1, and COL18A1, which have been reported previously. We found several candidate SNPs that were significantly associated with prolapse in Chinese women. Our results provide new evidence for further investigation of the involvement of these potential genes in the etiology of POP.

To evaluate and compare the clinical outcomes of the transobturator sling with the single-incision sling, for the treatment of stress urinary incontinence at a long-term follow-up.From October 2008 to October 2010, 94 patients who were enrolled and underwent either TVT-O, one of standard mid-urethral sling or TVT-S, one of single-incision mini-sling (SIMS) procedure. The study population was followed until February 2019. Surgical outcomes were analyzed by subjective and objective evaluations and Chinese version questionnaires. Data were analyzed by IBM 23.0 SPSS Statistics. The level of statistical significance was set at P 0.05.At the 10-year follow-up, 31(64.6%) TVT-O patients and 33(71.7%) TVT-S patients were still available. Objective cure and subjective satisfaction rate were not significantly different for TVT-O compared with TVT-S (P 0.05). However, TVT-S showed a greater drop in success from the second to the tenth year compared with TVT-O (15.1% vs 0% and 9.2% vs 3.2%, respectively). Both groups experienced significantly improved quality of life in the TVT-O group and in the TVT-S group (P 0.05). The total PISQ-12 scores at 10 years postoperatively of the TVT-O and TVT-S groups were 33.4(4.7) compared with 33.6(3.9) before surgery (P = 0.67 0.05) and 35.5(5.9) compared with 31.5(6.3) before surgery (P = 0.045 0.05).It is difficult to state that there is superiority of one sling over another sling without a significant difference. But TVT-O showed superior objective cure and subjective satisfaction rates and a less decline in success during 10 years compared with TVT-S.

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., Anterior vaginal prolapse (AVP), the most common form of pelvic organ prolapse, has deleterious effects on women’s health. Here the authors employ single-cell RNA-seq to construct a transcriptomic atlas of vaginal wall cells from AVP patients, and find that extracellular matrix dysregulation and immune reaction are associated with AVP.

Objective: The objective of this study is to assess the consistency between the WeChat-based Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) in Chinese and the paper version and to determine the test–retest reliability of the WeChat questionnaire. Methods: A total of 120 women aged between 24 and 69 years were recruited from the outpatient clinic at Peking Union Medical College Hospital and randomly assigned to two groups. All participants completed the WeChat and paper questionnaires twice. Group A completed the paper questionnaire before the WeChat version; Group B completed the WeChat questionnaire before the paper version. Two weeks later, all participants completed the questionnaires in the opposite order. Then, the reliability and validity of the two versions were assessed using Pearson correlation coefficients, intraclass correlation coefficients, and Bland-Altman graphs. Results: No significant difference in completion time was found between the two versions of the Chinese PISQ-12 (P = 0.67). Half of the participants (60/120) preferred the WeChat questionnaire, 15% (18/120) preferred the paper form (P

Objective The weak estrogenic-like effect of selective estrogen receptor modulator (SERM) may lead to series of endometrial lesions, including proliferation, hyperplasia, polyp formation, and even endometrial cancer. This study aimed to explore the effectiveness of different endometrial thickness in diagnosis of endometrial hyperplasia during SERM therapy in premenopausal patients. Methods The clinical data of 115 patients receiving hysteroscopic endometrial biopsy during SERM therapy in Peking Union Medical College Hospital, China from January 2010 to December 2018 were retrospectively analyzed. Results Average age at the beginning of SERM therapy was 43.4 ± 5.7 years old. Mean duration time of SERM therapy was 31.0 ± 22.1 months. The mean endometrial thickness was 14.3 ± 6.1 mm. 4 cases of atypical endometrial hyperplasia (3.5 %), and 4 cases of endometrial hyperplasia without atypia (3.5 %) were detected. Endometrial thickness was higher in endometrial hyperplasia patients than in no endometrial hyperplasia patients (18.8 vs 13.9 mm, p = 0.029). Endometrial thickness in 8 out of 8 endometrial hyperplasia patients and 38 out of 107 no endometrial hyperplasia patients were ≥ 15 mm (p = 0.002). The negative predictive value in the diagnosis of endometrial hyperplasia during SERM therapy in premenopausal patients was 100 % when endometrial thickness Conclusion Endometrial hyperplasia was less likely to occur in premenopausal patients during SERM therapy when endometrial thickness

Objective WeChat is a promising tool for capturing electronic data; however, no research has examined its use. This study evaluates the reliability and feasibility of WeChat for administering the Pelvic Floor Impact Questionnaire Short Form 7 questionnaire to women with pelvic floor disorders. Methods Sixty-eight pelvic floor rehabilitation women were recruited between June and December 2015 and crossover randomized to two groups. All participants completed two questionnaire formats. One group completed the paper version followed by the WeChat version; the other group completed the questionnaires in reverse order. Two weeks later, each group completed the two versions in reverse order. The WeChat version's reliability was assessed using intraclass correlation coefficients and test-retest reliability. Results Forty-two women (61.8%) preferred the WeChat to the paper format, eight (11.8%) preferred the paper format, and 18 (26.5%) had no preference. The younger women preferred WeChat. Completion time was 116.5 (61.3) seconds for the WeChat version and 133.4 (107.0) seconds for the paper version, with no significant difference (P = 0.145). Age and education did not impact completion time (P > 0.05). Consistency between the WeChat and paper versions was excellent. The intraclass correlation coefficients of the Pelvic Floor Impact Questionnaire Short Form 7 and the three subscales ranged from 0.915 to 0.980. The Bland-Altman analysis and linear regression results also showed high consistency. The test-retest study had a Pearson's correlation coefficient of 0.908, demonstrating a strong correlation. Conclusions WeChat-based questionnaires were well accepted by women with pelvic floor disorders and had good data quality and reliability.

The aim of the study was to evaluate the anatomical and functional outcomes of modified laparoscopic sacrocolpopexy (MLSC) for the treatment of advanced pelvic organ prolapse (POP).From May 2009 to September 2012, a consecutive prospective observational study of 30 participants was conducted to evaluate MLSC as a treatment for symptomatic advanced POP at Peking Union Medical College Hospital. The Pelvic Organ Prolapse Quantification (POP-Q) classification was used to determine the POP stage. Validated tools were used to evaluate symptoms (Pelvic Floor Distress Inventory, PFDI-20) and sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, PISQ-12). Measurements were recorded preoperatively and then at 3 months and yearly after surgery. We compared the follow-up results with the preoperative data.All participants completed a 3-year clinical follow-up routine. The anatomical results at 3 months showed significant improvements (P 0.05) compared with the preoperative results based on the POP-Q measurements. This improvement remained significant after 3 years (P 0.05). The anatomical cure rate was 100% and 96.7% at 3 months and 3 years after surgery, respectively. Pelvic floor function remained significantly improved after surgery compared with preceding surgery (P 0.05) according to the following measures: PFDI-20 (106.2 vs 36.0), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6, 47.9 vs 13.7), Colorectal-Anal Distress Inventory-8 (CRADI-8, 29.2 vs 9.2), and Urinary Distress Inventory-6 (UDI-6, 29.2 vs 13.2). The participants maintained a high level of sexual function (PISQ-12: 29.0 vs 35.1, P 0.05). One case of mesh exposure (3.3%) and two cases of de novo dyspareunia (8.7%) were observed.MLSC seems to be a safe and effective procedure that achieves good long-term anatomical and functional results.

Background: Pelvic organ prolapse (POP) is a major health problem in adult women that involves many factors. No proteomic analysis has been conducted exclusively in POP patients. This study aimed to identify the differential expression of proteins that may be involved in POP by proteomic analysis. Methods: Samples of the uterosacral ligament (USL) were collected from five POP patients and five non-POP patients matched according to age, parity, and menopausal status and analyzed using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Quantitative real-time polymerase chain reaction (qRT-PCR) was used to verify the mRNA expression of proteins that showed differential expression in the proteomic analyses. Results: Proteins differentially expressed between POP and non-POP patients were detected. Eight proteins that were down-regulated in the POP group were identified by MALDI-TOF-MS. These proteins included electron transfer flavoprotein, apolipoprotein A-I, actin, transgelin, cofilin-1, cyclophilin A, myosin, and galectin-1, and their expression was verified by qRT-PCR. Conclusion: Using comparative proteomics, we identified eight differentially expressed proteins (including four cytoskeleton proteins and three proteins related to apoptosis) in the USL that may be involved in apoptosis associated with the tissue effects in POP pathophysiology.

Aim This study aimed to compare the outcomes of pelvic floor muscle training (PFMT) between postpartum and non-postpartum women with stress urinary incontinence (SUI) and to detect potential factors that may influence these outcomes. Methods A total of 54 and 79 participants were recruited into postpartum (PP group) and non-postpartum (non-PP group) groups, respectively. A physiotherapist treated the participants twice a week for 6-8 weeks. At baseline and 6 and 12 months after treatment, the 1-h pad weight test (PWT), vaginal contraction pressure (VCP), and Incontinence Impact Questionnaire Short Form (IIQ-7) were assessed by an evaluator or physiotherapist. The primary outcome was PWT improvement. The participants whose PWT improvement reached a >50% reduction relative to baseline were considered responders. Secondary outcomes included VCP, IIQ-7 score, and patient satisfaction rate. Results The PWT improvement was 87.04% (95%CI: 0.78, 0.96) in the PP group at 1-year follow-up, which was significantly better than the 72.15% improvement (95%CI: 0.62, 0.82) in the non-PP group (OR = 2.591, 95%CI: 1.018, 6.595, P = 0.041). Changes in VCP and BMI were significant predictors of responders in the regression analysis. As the change in VCP increased by 1 cmH2 O, the efficiency increased by 4.2% (OR = 1.042, 95%CI: 1.010, 1.070). The change in BMI increased by 1 kg/m2 , and the efficiency decreased 23.0% (OR = 0.770, 95%CI: 0.633, 0.937). Conclusions The outcome of PFMT in postpartum participants with SUI was better than that in non-postpartum participants. Women with more improvements in VCP and weight loss showed better amelioration of SUI symptoms after PFMT.

Background: Although repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction, the data about posterior compartment are scarce. The aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse (POP). Methods: This was a prospective, double-blind, clinical pilot study of 22 postmenopausal women with symptomatic POP (overall POP-quantification [POP-Q] Stage III-IV) who underwent total pelvic floor reconstruction. Patients were grouped according to the use of mesh for posterior vaginal compartment repair: A mesh group and a nonmesh group. POP-Q stage, the pelvic floor impact questionnaire short form-7 (PFIQ-7) and anorectal manometry were evaluated before and 3 months after surgery. Anatomical success was defined as POP-Q Stage II or less. A t-test was used to compare preoperative with postoperative data in the two groups. Results: Totally, 17 (71%) were available for the follow-up. POP-Q measurements improved significantly compared to baseline (P < 0.05) in both groups. No recurrence was observed. Subjects in both groups reported improvement in pelvic floor symptoms, and there was no significant difference in the PFIQ-7 score between groups at follow-up (P > 0.05). Compared with baseline, the nonmesh group exhibited a statistically significant decrease in anal residual pressure, a significant increase in the anorectal pressure difference during bowel movement, and a reduced rate of dyssynergia defecation pattern (P < 0.05). Conclusions: Provided there is sufficient support for the anterior wall and apex of vagina with mesh, posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.

OBJECTIVE The aim of this study was to introduce a new pelvic reconstructive surgical operation with use of specially designed puncture needles and precut mesh. In addition, the anatomic results and the safety of this reconstructive approach were evaluated. METHODS Ninety-nine women who were older than 60 years with stage III or IV prolapse according to pelvic organ prolapse quantification (POP-Q) underwent the modified pelvic reconstructive surgical operation. Follow-up was more than 1 year. The objective and subjective results were measured by POP-Q and quality-of-life questionnaires, respectively. Complications were also observed both in the surgical operation and in the follow-up examination. RESULTS No severe intraoperative complications were observed. POP-Q measurements of Ba, Bp, and C taken 1 year postoperatively were significantly improved compared with those at baseline (P < 0.001), but eight women (8.1%) showed recurrence. A significant improvement in quality-of-life scores was observed (P < 0.001). The incidence rate of mesh exposure and the de novo urgent incontinence rates were 2% and 12%, respectively. CONCLUSIONS This new pelvic reconstructive surgical operation is a cost-effective and safe method and is easy to perform.

To evaluate the results of etoposide/ methotrexate/actinomycin D/etoposide/cisplatin (EMA/ EP) chemotherapy in patients with chemorefractory gestational trophoblastic tumor (GTT).Fifteen patients with chemorefractory GTT were treated with EMA/EP.Twelve of the 15 cases were choriocarcinoma, and the last 3 were metastatic placental site trophoblastic tumor (PSTT): International Federation of Gynecology and Obstetrics (FIGO) stage I, 2 cases; stage III, 10 cases; stage IV, 3 cases. Seven cases have FIGO score 7-10; the scores of the remaining 8 cases were10. Fifteen patients received a total of 93 cycles of the study regimen. The median number of courses for each patient was 6.2. Eleven cases (73.3%) achieved complete remission, while 3 (20%) had partial remission; 1 case (6.7%) showed no response. The main complications of EMA/EP chemotherapy were myelosuppression and gastrointestinal symptoms.The EMA/EP regimen is effective for chemorefractory GTT, and the chemotherapeutic results can be improved when combined with surgery and arterial infusion chemotherapy in selected patients. The EMA/EP regimen should be considered for primary management of metastatic PSTT.

To investigate the histological characteristics in uterine ligaments of stress urinary incontinence (SUI) and pelvic organ prolapse (POP); to detect the alteration of collagen ultrastructure in uterine ligaments that contribute to SUI and POP; to study the relationship between collagen alteration and SUI and POP.The cardinal ligament (Car lig.) and uterosacral ligaments (U-S lig.) samples were obtained from 73 subjects suffering from SUI, or normal controls who underwent hysterectomy. Collagen ultrastructure was examined with transmission electron microscopy (TEM).1) The smooth muscle fascicles in the patients with SUI and POP were thinner. Arrangement of smooth muscle fascicles was in disorder. 2) The collagen constituting the ligaments was active in metabolism. The mean collagen fibril diameters in the SUI and POP groups were about 25% larger than that in the control groups (por = 0.01). 3) Histological characteristics of the Car lig. and the U-S lig. were similar.1) The Car lig. and U-S lig. are homologous. Abnormalities in arrangement of smooth muscles and the collagen ultrastructure were obviously seen in SUI and POP 2) The collagen fibril diameter in the SUI and POP subgroups was significantly larger than that in the control groups. Those ligaments are probably less elastic and more likely to break. Predominance of collagen degradation during tissue repair may contribute to POP and SUI.