The role of tenascin-X in the uterosacral ligaments of postmenopausal women with pelvic organ prolapse: an immunohistochemical study.

INTRODUCTION AND HYPOTHESIS: Abnormalities of connective tissue structure or its repair mechanism may predispose women to pelvic organ prolapse (POP). We hypothesized that the expression of tenascin-X in the uterosacral ligament of postmenopausal women with symptomatic POP is increased compared with postmenopausal women without POP. Furthermore, we identified clinical risk factors associated with POP in our study population. METHODS: We conducted a retrospective case-control study in which 33 postmenopausal women with symptomatic POP ≥ pelvic organ prolapse quantification system (POP-Q) stage II were matched with 33 postmenopausal women without POP. Studied tissue specimens were taken from hysterectomy specimens, and tenascin-X expression was investigated by immunohistochemistry. The immunohistochemical profile of the uterosacral connective tissue of cases and controls was compared. RESULTS: Tenascin-X was expressed in 94% of POP cases and in 91% of controls. Our study failed to show any statistically significant differences in tenascin-X expression between women with and without POP (p = 0.64). However, tenascin-X was significantly more expressed in cases with severe prolapse (POP-Q stage IV) compared with moderate prolapse stages (POP-Q stage II and III) (p = 0.001). Advanced patient age as well as early menopausal age remained independent risk factors associated with POP in multiple logistic regression analysis (p = 0.001). CONCLUSION: No difference could be demonstrated between tenascin-X expression in patients with or without POP. Tenascin-X does not seem to play a major role in the pathogenesis of POP in postmenopausal women.

Pelvic organ prolapse and endogenous circulating sex steroids in postmenopausal women: A case control-study.

OBJECTIVE: We compared sex steroid levels of postmenopausal patients with symptomatic pelvic organ prolapse (POP) with postmenopausal matched patients without any sign of POP. Furthermore, we evaluated a possible relationship between sex steroid levels and various urogynecologic parameters in cases with POP. Main outcome of interest were differences in circulating estradiol levels between the two groups. STUDY DESIGN: We conducted a case-control study and 46 postmenopausal women with symptomatic POP≥stage 2 were matched 1:1 with 46 urogynecologic healthy women. Blood samples were drawn from all patients for assessment for estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), testosterone (T), androstendion (AEON), dehydroepiandrosterone sulphate (DHEAS) and sex hormone binding globulin (SHBG) with an Electrochemiluminescence immunoassay. RESULTS: Our study failed to show any statistically significant differences in sex steroid levels between women with and without POP (p>0.05). However, serum concentration of E2 (p<0,0001), free testosterone (p=0,034) and DHEAS (p=0,024) was statistically significant lower in patients with severe prolapse stage. Serum levels of E2 were statistically significant higher in cases with moderate-strong Oxford Grading Scale (p<0,0001). Low circulating E2 (p=0,019) as well as menopausal age (p=0,022) remained independent risk factors for POP in multiple logistic regression analysis. CONCLUSION: The significant low hormonal levels in cases with high POP-Q stage as well as the significant higher estradiol levels in patients with strong Oxford Grading Scale may indicate that endogenous circulating sex steroids might have a potential role in the severity and progression of POP.

Prognostic Significance of Pre-treatment Serum C-Reactive Protein Level in Patients with Adenocarcinoma of the Uterine Cervix.

AIM: To evaluate pre-treatment serum C-reactive protein (CRP) level as a prognostic parameter in patients with adenocarcinoma of the uterine cervix. MATERIALS AND METHODS: Pre-treatment CRP levels were analyzed to determine potential associations with clinicopathological parameters and to assess prognostic value in 46 patients with sole adenocarcinoma of the uterine cervix. RESULTS: The mean (±SD) pre-treatment serum CRP level was 5.82 (7.21) mg/l. Serum CRP concentration significantly correlated positively with age at diagnosis (p=0.001), lymphovascular space invasion (p=0.0026), recurrent disease (p=0.0001) and International Federation of Gynecology and Obstetrics (FIGO) stage (p=0.0002). In multivariate Cox regression models with age, FIGO stage, histological grade and lymph node status, elevated CRP and cancer antigen 125 levels were associated with shortened survival (p<0.05). Overall 5-year survival rate of patients with pre-treatment serum CRP level <5.0 mg/l was 100% compared to 46.9% for patients with pre-treatment CRP level ≥5.0 mg/l. CONCLUSION: Serum CRP level can be seen as an additional independent prognostic parameter in patients with the rare histological subtype adenocarcinoma of the uterine cervix.

Pelvic floor symptoms in female cyclists and possible remedies: a narrative review.

INTRODUCTION AND HYPOTHESIS: Cycling has become a popular athletic activity worldwide and can lead to genital and pelvic floor dysfunction. This review summarizes the current body of evidence about the epidemiology of genital and pelvic floor symptoms in female cyclists, the therapy, and preventive interventions. METHODS: Two electronic meta-databases, OvidSP™ and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI), comprising 40 individual databases, were searched for studies that described genital and pelvic floor symptoms in association with cycling and studies that tested possible therapies and prophylactic measures. For the literature search we explored the search terms "female", "bicycling", "pelvic floor", "lower urinary tract symptoms", and "vulvar diseases". RESULTS: The search retrieved 1,219 articles, leaving 763 articles after removal of duplicates, and finally 12 articles eligible for review. We assessed 10 observational and 2 experimental studies. Genital and pelvic floor symptoms related to bicycling were pain, tenderness, neuropathy, urological dysfunction and skin lesions. Broader and conventionally shaped saddles were associated with fewer symptoms compared with cut-out saddle designs. CONCLUSION: The quality of existing studies is generally low, but there is evidence that female cyclists suffer from similar problems to male cyclists, ranging from minor skin lesions to severe sequelae such as pain and neurological deficiencies.