Histologic and metabolic assessment in a cohort of patients with genital prolapse: preoperative stage and recurrence investigations.

BACKGROUND: Biological basis of prolapse development and recurrence are still unclear. Aim of this observational and prospective study is to correlate clinical stage of anterior vaginal wall prolapse and anatomical recurrence to histological and metabolic characteristics of vaginal tissue. METHODS: Patients undergoing surgery were divided into two groups according to anterior stage ≤II (group A) and ≥III (group B). Full-thickness excisional biopsies of the anterior vaginal wall were obtained after hysterectomy. Hystological characteristics and metalloproteinases activity (MMP-2) were analyzed. RESULTS: Sixty-nine patients (35 group A; 34 group B) completed evaluation. Mean follow-up was 35 months. Collagen amount and organization were significantly higher in group B both in lamina propria and fascia specimens, but MMP-2 activity was significantly lower in this group. Recurrence rate of anterior compartment was 10.1%. Collagen cellularity of fascia was higher in recurrence groups. On the contrary MMP-2 activity showed a close to significant correlation to surgical success (P=0.07). CONCLUSIONS: Patients with advanced stages of prolapse have increased collagen amount associated to decreased MMP-2 activity. This suggests that connective tissue is more abundant but less metabolically active in patients with severe prolapse. A similar trend can be found in recurrences.

Voiding disorders as etiologic cofeature of overactive bladder syndrome. An observational study.

BACKGROUND: Overactive bladder (OAB) is very common in the urological and gynecological practice. It is well known that the correlation between clinical features and urodynamics findings is often poor. In this observational study urodynamic findings of an OAB population have been retrospectively analyzed with the aim to identify a possible role of voiding disorders in the pathophysiology of OAB syndrome. METHODS: Urodynamics executed between January 2005 and December 2010 have been analyzed. Female patients presenting characteristics of OAB syndrome according to International Continence Society definition were identified. Urodynamic investigations have been carried out according to the good practice guidelines for urodynamics. The Blaivas-Groutz cut off for female urinary obstruction was to detect voiding disorders. RESULTS: According to the selection criteria 258 patients presenting OAB syndrome have been considered eligible to join the study. Eighty-one patients (30%) showed voiding difficulties: in 21 of them pressure-flow study was diagnostic for frank outlet obstruction, in 47 a mild form and 13 bladder sphincter pseudo-dyssynergia. CONCLUSIONS: OAB syndrome can be related to voiding disorders mostly represented by a mild degree of obstruction. Such condition could trigger irritative symptoms. These clinical findings require an instrumental assessment represented by a pressure-flow analysis. This approach seems to be mandatory in patients refractory to drug therapy.