Expressions of homeobox, collagen and estrogen genes in women with uterine prolapse.

OBJECTIVE: Genetic contribution is thought to be involved in the pathophysiology of pelvic organ prolapse (POP). We aimed to study the gene expression profiles of the genes HomeoboxA11 (HOXA11), HomeoboxA13 (HOXA13), Collagen Type I (COL1A), Collagen Type III (COL3A), estrogen receptor genes (ESR1 and ESR2) of round (RL) and uterosacral ligaments (USL) in postmenopausal women with uterine prolapse. STUDY DESIGN: Gene expressions of 32 postmenopausal women with prolapse were analysed according to gene expressions of 8 postmenopausal women without prolapse. Quantitative real-time PCR (qRT-PCR) method was used for the detection of expression levels of the genes. Student's t-Test and Mann-Whitney U test were used for statistical analysis. RESULTS: In the USL specimens of all women with uterine prolapse HOXA13 and ESR1 gene expressions were decreased compared to controls (0.5 fold, p = 0.04 and 0.82 fold, p = 0.04, respectively). In the RL specimens, ESR2 gene expression was decreased 0.7 fold in women with prolapse when compared to controls (p = 0.04). In the USL specimens of women with advanced stages of prolapse (stage ≥3), HOXA13 and COL3A gene expressions were decreased compared to controls (0.44 fold, p = 0.043 and 0.39 fold, p = 0.045, respectively). In the RL specimens, ESR2 gene expression was decreased 0.65 fold in women with prolapse when compared to controls (p = 0.052). CONCLUSION: The significant decrease in the expression of the genes HOXA13, COL3A in the USL and ESR2 in the RL especially in advanced stages of prolapse, implicate that these gene expressions may play a role in the development of uterine prolapse.

Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle.

OBJECTIVE(S): To present data of standardized ambulatory urodynamic monitoring (AUM) performed in women with overactive bladder syndrome (OAB) and to evaluate the relevance of AUM data with clinical findings of the patients. STUDY DESIGN: Records of women with symptoms of OAB were retrospectively reviewed (n=249). Of women fulfilling the Overactive Bladder Awareness Tool (OAB-V8) with a score ≥8 and the 3-day voiding diary (VD) with a frequency >7/day (n=167), those who underwent urodynamic investigation were selected (n=76). The data of this study were retrieved from the records of Ankara University Cebeci Hospital and based on the AUM findings of single voiding cycle of women with OAB. AUM, which is among the institutionally approved primary urodynamic investigation methods, is performed with LUNA ambulatory monitoring recorder (MMS™) in the clinical setting with a standardized technique, in reproducing lower urinary tract symptoms of women since 2011. The relationship of the urodynamic data with the clinical findings were evaluated. RESULTS: AUM traces of women (n=76) with OAB revealed 63.1% DO, 64.4% urgency and 77.7% urinary incontinence of which were 14.4% urgency urinary incontinence (UUI), 25% stress urinary incontinence (SUI) and 38.1% mixed urinary incontinence (MUI). OAB patients with DO reported more urinary incontinence episodes/day, nocturia and mixed urinary incontinence in the voiding diary (p<0.04) and had significantly higher irritative symptom bother reflected by the questionnaires (p<0.04). Women with DO were more likely to be postmenopausal (p=0.02) and were found to have more urgency (p<0.001), urgency episodes (p=0.05) and incontinence (urge and mixed) (p<0.001). However, no association was found between the extent of pelvic organ prolapse and the presence of DO. CONCLUSIONS: AUM performed with a standardized technique during single voiding cycle seems to be a reliable method in reproducing symptoms of women with OAB. It provides both clinically relevant findings and objective documentation of urgency which is the main symptom for OAB. The detection of DO according to the ICS definition were also found to be concordant with urodynamicaly observed urgency and urinary incontinence. Objective and subjective clinical findings of OAB were found to be more severe in women with DO.