Manifestations of undifferentiated connective tissue dysplasia and prediction of recurrence after surgical correction of anterior pelvic organ prolapse in women
- Authors: Marinkin I.O.1, Rakitin F.A.2, Volchek A.V.1, Soluyanov M.Y.2, Kuleshov V.M.1, Makarov K.Y.1, Sokolova T.M.1, Nimaev V.V.2, Aidagulova S.V.1
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Affiliations:
- Novosibirsk State Medical University, Ministry of Health of Russia
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
- Issue: No 12 (2024)
- Pages: 70-79
- Section: Original Articles
- URL: https://journals.rcsi.science/0300-9092/article/view/282530
- DOI: https://doi.org/10.18565/aig.2024.208
- ID: 282530
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Abstract
Pelvic organ prolapse (POP) is a significant global health problem in women.
Objective: To examine the prevalence of clinical and phenotypic manifestations of undifferentiated connective tissue dysplasia (uCTD) in patients with anterior POP and investigate the recurrence rate after surgical treatment to develop a prognostic model for the selection of mesh or native implants.
Materials and methods: A study was conducted involving 460 patients aged 40–82 years who were diagnosed with anterior POP using the Pelvic Organ Prolapse Quantification system (POP-Q ISC, 1996). Patients were examined and underwent vaginal surgery using mesh or native implants in the gynecology department of the Research Institute of Clinical and Experimental Lymphology from 2015 to 2023. The patients were divided into two groups depending on the surgical treatment method for POP. Group 1 included 242 women aged 60 (56; 64) years, who underwent surgery using a mesh implant (transvaginal system cysto-swing, France), while Group 2 included 218 patients aged 66 (62; 68) years, who underwent surgery using native tissues.
Results: Among 328 patients in both groups, clinical manifestations of uCTD of moderate (50.87%) and severe (20.43%) grades prevailed. Pronounced manifestations of uCTD accounted for 71.3%, with no statistically significant differences in uCTD scores between groups 1 and 2. The most significant predictors of POP recurrence in patients with mesh implants, in descending order, were varicose veins (VV) and/or hemorrhoids that required surgical treatment, chronic bronchopulmonary diseases (CBPD), and vegetative-vascular dystonia (VVD). These manifestations of uCTD were also significant in group 2, with additional manifestations including hernias of various localizations, a tendency toward allergic and cold diseases, and an asthenic body type.
Conclusion: The modeling results identified three manifestations of uCTD that are universal predictors of the recurrence of anterior POP: VVD (a minor manifestation of uCTD), CBPD (a major sign of uCTD), and VV (severe manifestations of uCTD). If three additional manifestations of uCTD are identified, namely, an asthenic body type, a tendency toward allergic and cold diseases, and hernias of various localizations, it is advisable to opt for a mesh implant immediately.
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##article.viewOnOriginalSite##About the authors
Igor’ O. Marinkin
Novosibirsk State Medical University, Ministry of Health of Russia
Email: rector@ngmu.ru
ORCID iD: 0000-0002-9409-4823
Dr. Med. Sci., Professor, Head of the Obstetrics and Gynecology Department, Rector
Russian Federation, Krasny Ave., 52, Novosibirsk, 630091Fedor A. Rakitin
Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
Email: rakitinfedorr@mail.ru
ORCID iD: 0000-0002-5927-6883
Gynecologist, Senior Researcher, Research Institute of Clinical and Experimental Lymphology
Russian Federation, Ac. Lavrentyev str., 10, Novosibirsk, 630060Alexander V. Volchek
Novosibirsk State Medical University, Ministry of Health of Russia
Email: alexander@volcheck.ru
ORCID iD: 0000-0003-4458-1188
Gynecologist, Senior Researcher
Russian Federation, Krasny Ave., 52, Novosibirsk, 630091Mikhail Yu. Soluyanov
Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
Email: msoluyanov@mail.ru
ORCID iD: 0000-0003-2635-9161
PhD, Researcher at the Laboratory of Operative Lymphology and Lymphodetoxication, Research Institute of Clinical and Experimental Lymphology
Russian Federation, Ac. Lavrentyev str., 10, Novosibirsk, 630060Vitaliy M. Kuleshov
Novosibirsk State Medical University, Ministry of Health of Russia
Email: kuleshov_vm@mail.ru
ORCID iD: 0000-0003-3304-1581
Dr. Med. Sci., Professor, Obstetrics and Gynecology Department
Russian Federation, Krasny Ave., 52, Novosibirsk, 630091Konstantin Yu. Makarov
Novosibirsk State Medical University, Ministry of Health of Russia
Email: fdpngma@mail.ru
ORCID iD: 0000-0003-3574-6382
Dr. Med. Sci., Professor, Obstetrics and Gynecology Department
Russian Federation, Krasny Ave., 52, Novosibirsk, 630091Tatyana M. Sokolova
Novosibirsk State Medical University, Ministry of Health of Russia
Email: tatyana3965@mail.ru
ORCID iD: 0000-0003-3435-3536
Dr. Med. Sci., Professor, Obstetrics and Gynecology Department
Russian Federation, Krasny Ave., 52, Novosibirsk, 630091Vadim V. Nimaev
Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
Email: nimaevvv@yandex.ru
ORCID iD: 0000-0002-9889-3729
Dr. Med. Sci., Head of the Laboratory of Operative Lymphology and Lymphodetoxication, Research Institute of Clinical and Experimental Lymphology
Russian Federation, Ac. Lavrentyev str., 10, Novosibirsk, 630060Svetlana V. Aidagulova
Novosibirsk State Medical University, Ministry of Health of Russia
Author for correspondence.
Email: asvetvlad@yandex.ru
ORCID iD: 0000-0001-7124-1969
Dr. Bio. Sci., Professor, Head of the Laboratory of Cellular Biology and Fundamental Basis of Reproduction, Central Research Laboratory
Russian Federation, Krasny Ave., 52, Novosibirsk, 630091References
- Краснопольская И.В. Дисфункция тазового дна у женщин: Клиника, диагностика, принципы лечения. Акушерство и гинекология. 2018; 2: 82-6. [Krasnopolskaya I.V. Pelvic floor dysfunction in women: clinical presentation, diagnosis, and principles of treatment. Obstetrics and Gynecology. 2018; (2): 82-6. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.2.82-86.
- American College of Obstetricians and Gynecologists and the American Urogynecologic Society; INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. Pelvic Organ Prolapse. Female Pelvic Med. Reconstr. Surg. 2019; 25(6): 397-408. https://dx.doi.org/10.1097/SPV.0000000000000794.
- Смольнова Т.Ю., Чупрынин В.Д. Пролапс гениталий: взгляд на проблему. Акушерство и гинекология. 2018; 10: 33-40. [Smolnova T.Yu., Chuprynin V.D. Genital prolapse: a look at the problem. Obstetrics and Gynecology. 2018; (10): 33-40. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.10.33-40.
- Tunn R., Baeßler K., Knüpfer S., Hampel C. Urinary incontinence and pelvic organ prolapse in women. Prevention and treatment. Dtsch. Arztebl. Int. 2023; 120: 71-9. https://dx.doi.org/10.3238/arztebl.m2022.0406.
- Радзинский В.Е., Ханзадян М.Л., Демура Т.А. Матриксные металлопротеиназы и их ингибиторы в патогенезе пролапса тазовых органов. Доктор.Ру. 2014; S1: 7-10. [Radzinsky V.E., Khanzadyan M.L., Demura T.A. Matrix metalloproteinases and their inhibitors in the pathogenesis of pelvic organ prolapse. Doctor.Ru. 2014; S1: 7-10. (in Russian)].
- Lim V.F., Khoo J.K., Wong V., Moore K.H. Recent studies of genetic dysfunction in pelvic organ prolapse: the role of collagen defects. Aust. N. Z. J. Obstet. Gynaecol. 2014; 54(3): 198-205. https://dx.doi.org/10.1111/ajo.12169.
- Васин Р.В., Филимонов В.Б., Мнихович М.В., Каприн А.Д., Костин А.А., Васина И.В. Морфологическая структура и иммуногистохимический анализ стенок влагалища у женщин с пролапсом гениталий. Урология. 2019; 6: 12-20. [Vasin R.V., Filimonov V.B., Mnikhovich M.V., Kaprin A.D., Kostin A.A., Vasina I.V. Morphologic structure and immunohistochemical analysis of vaginal wall in women with pelvic organ prolapsed. Urologiia. 2019; (6): 12-20. (in Russian)]. https://dx.doi.org/10.18565/urology.2019.6.12-20.
- Смольнова Т.Ю., Савельев С.В., Буянова С.Н., Титченко Л.И., Гришин В.Л., Яковлева Н.И. Фенотипический симптомокомплекс дисплазии соединительной ткани у женщин. Клиническая медицина. 2003; 81(8): 42-7. [Smolnova T.Yu., Buyanova S.N., Savelyev S.V., Titchenko L.I., Grishin V.L., Yakovleva N.I. The phenotypical symptom complex of connective tissue dysplasia in females. Clinical Medicine. 2003; 81(8): 42-7. (in Russian)].
- Трунченко Н.В., Макаров К.Ю., Киселева Т.В., Крашенинникова О.О., Айдагулова С.В., Маринкин И.О. Особенности хронического эндометрита у пациенток репродуктивного возраста с недифференцированной дисплазией соединительной ткани. Сибирский научный медицинский журнал. 2017; 37(1): 99-104. [Trunchenko N.V., Makarov K.Yu., Kiseleva T.V., Krasheninnikova O.O., Aidagulova S.V., Marinkin I.O. Chronic endometritis peculiarities in reproductive-age women with undifferentiated connective tissue dysplasia. Siberian Scientific Medical Journal. 2017; 37(1): 99-104. (in Russian)].
- Clark B.A., Sekhon A. Nephroptosis in a young woman with joint laxity. Nat. Rev. Nephrol. 2009; 5(12): 722-5. https://dx.doi.org/10.1038/nrneph.2009.169.
- Coolen A.W.M., Bui B.N., Dietz V., Wang R., van Montfoort A.P.A., Mol B.W.J. et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int. Urogynecol. J. 2017; 28(12): 1767-83. https://dx.doi.org/10.1007/s00192-017-3493-2.
- Fritel X., de Tayrac R., de Keizer J., Campagne-Loiseau S., Cosson M., Ferry P. et al. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry. BJOG. 2022; 129(4): 656-63. https://dx.doi.org/10.1111/1471-0528.16892.
- Jha S., Cutner A., Moran P. The UK National Prolapse Survey: 10 years on. Int. Urogynecol. J. 2018; 29(6): 795-801. https://dx.doi.org/10.1007/s00192-017-3476-3.
- Dällenbach P., Jungo Nancoz C., Eperon I., Dubuisson J.B., Boulvain M. Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse. Int. Urogynecol. J. 2012; 23(1): 35-41. https://dx.doi.org/10.1007/s00192-011-1483-3.
- Bodner-Adler B., Bodner K., Carlin G., Kimberger O., Marschalek J., Koelbl H. et al. Clinical risk factors for recurrence of pelvic organ prolapse after primary native tissue prolapse repair. Wien Klin. Wochenschr. 2022; 134(1-2): 73-5. https://dx.doi.org/10.1007/s00508-021-01861-8.
- Maher C., Feiner B., Baessler K., Christmann-Schmid C., Haya N., Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst. Rev. 2016; 11(11): CD004014. https://dx.doi.org/10.1002/14651858.CD004014.pub6.
- da Silveira S.D.R.B., Auge A.P., Jarmy-Dibella Z.I., Margarido P.F., Carramao S., Alves Rodrigues C. et al. A multicenter, randomized trial comparing pelvic organ prolapse surgical treatment with native tissue and synthetic mesh: a 5-year follow-up study. Neurourol. Urodyn. 2020; 39(3): 1002-11. https://dx.doi.org/10.1002/nau.24323.
- Carroll L., Sullivan C.O., Doody C., Perrotta C., Fullen B.M. Pelvic organ prolapse: women's experiences of accessing care & recommendations for improvement. BMC Women's Health. 2023; 23(1): 672. https://dx.doi.org/10.1186/s12905-023-02832-z.
- Siff L.N., Barber M.D., Zyczynski H.M., Rardin C.R., Jakus-Waldman S., Rahn D.D. et al.; NICHD Pelvic Floor Disorders Network. Immediate postoperative pelvic organ prolapse quantification measures and 2-year risk of prolapse recurrence. Obstet. Gynecol. 2020; 136(4): 792-801. https://dx.doi.org/10.1097/AOG.0000000000004043.
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