Relationship of MMPs/TIMPs expression and extracellular matrix component levels in uterosacral ligament with apoptosis in patients with stress urinary incontinence

Objective: To study the relationship of MMPs/TIMPs expression and extracellular matrix component levels in uterosacral ligament with apoptosis in patients with stress urinary incontinence (SUI). Methods: A total of 48 patients who were diagnosed with stress urinary incontinence and received surgical treatment in Zigong First People's Hospital between May 2011 and October 2016 were selected as SUI group, and 30 patients who received vaginal hysterectomy for benign tumor during the same period were selected as control group. The uterosacral ligament was collected during operation to determine the mRNA expression of MMPs/TIMPs and apoptosis genes as well as the levels of extracellular matrix components. Results: MMP1, MMP2, MMP9, MMP14, Bax, Caspase-3, Caspase-9 and LC3-II mRNA expression in uterosacral ligament of SUI group were significantly higher than those of control group while TIMP1, TIMP2 and TIMP3 mRNA expression as well as Col-I, Col-III, Elastin, PYD and Fibulin-5 levels were significantly lower than those of control group;Bax, Caspase-3, Caspase-9 and LC3-II mRNA expression in uterosacral ligament were positively correlated with MMP1, MMP2, MMP9 and MMP14 mRNA expression, and negatively correlated with TIMP1, TIMP2 and TIMP3 mRNA expression as well as Col-I, Col-III, Elastin, PYD and Fibulin-5 levels. Conclusion: The excessive apoptosis in uterosacral ligament of patients with stress urinary incontinence is related to the imbalance of MMPs/TIMPs and the excessive degradation of extracellular matrix components.

Proteomic Analysis of the Uterosacral Ligament in Postmenopausal Women with and without Pelvic Organ Prolapse

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.

Clinical analysis of laparoscopic lateral peritoneal suspension in the treatment of severe pelvic organ prolapse

Objective:To investigate the clinical effects of laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse(POP).Methods:Thirty-eight patients who underwent laparoscopic lateral peritoneal suspension for pelvic organ prolapse in the gynecology department of our hospital from January 2019 to January 2020 were selected for retrospective analysis.Postoperative outcomes were recorded for patients at 3,6,and 12 months postoperatively.Results:All 38 patients completed the surgery safely,and the duration of surgery was 85-190 min,with a mean of(138±40.75)min;surgical bleeding was 30-80 ml,with a mean of(57±35.4)ml;the duration of postoperative catheterization was 4-6 days,with a mean of(5±0.73)days;postoperative hospitalization was 6-12 days,with a mean of(8.49±2.18)days.2.18)days.At 3,6,and 12 months after the end of surgery,all follow-up patients had their uterus and anterior vaginal wall restored to normal position without prolapse.The pelvic floor rehabilitation of the patients after surgery was good and their sexual life was significantly improved in all cases.Conclusion:Laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse is safe,efficacious,minimally traumatic,less painful,with short hospital stay,fast postoperative recovery,greater choice of uterine de-positioning,with the advantages of permanence and good pelvic floor anatomical recovery,and this procedure can maintain a certain vaginal length with 100%efficiency,which is worthy of clinical promotion.

Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

The uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. These 2 ligaments provided 4 points support at the apex. Here we describe our surgical technique of robotic assisted laparoscopic apical suspension (RALAS) using non-absorbable sutures and describe a new 4 points technique (RALAS-4). 73-year-old Caucasian woman, gravida 5, para 4 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound evaluation the uterus was small and normal appearing of adnexa bilaterally. She failed pessaries and was sexually active. The most relevant complaints were vaginal bulging, pressure and urinary incontinence, mainly stress urinary incontinence;she is using 5 - 7 pads/day. Robotic assisted laparoscopic hysterectomy, mid-urthral sling and apical suspension was successfully performed in 125 min. Once we finished with hysterectomy, we proceed with RALAS-4, we used V-Loc 3-0, CV-23 (Covidien) sutures (absorbable) on the right and left uterosacral ligaments (2 points) and theses were reinforced with Gore-Tex 2-0, CV-2 (non-absorbable, Gore Medical). On the right/left anterior apical support we used Gore-Tex 2-0 and these provided the 2 point suspension (UTLS = 2 and anterior vagina = 2). The 2 anterior apical support sutures are taken from the vagina to the transversalis fascia and the obliterated umbilical artery on the anterior abdominal wall. The tension of these anterior sutures was maintained with Hem-o-lock (TeleFlex) and LAPRA-TY (Ethicon). In our opinion RALAS-4 may represents an alternative to robotic or laparoscopic sacrocolpopexy. This new approach simulate the natural 4 points support given by uterosacral ligaments and cardinal ligament, with the additional benefit of no mesh and no dissection on the sacrum promontory. With this technique we are chasing the Trifecta: no mesh, no complications and good anatomic support.

Characteristics of pathological findings in women with chronic pelvic pain using conscious mini-laparoscopic pain mapping

Chronic pelvic pain （CPP） is a common and disabling disorder of women that may have a significant impact on a woman＇s personal health and quality of life.Data have shown an annual prevalence of 3.8% in women 15 to 73 years of age, making its prevalence comparable to that of asthma （3.7%）, back pain （4.1%）, and migraines （2.1%）. CPP in women is described as ＂intermittent or constant pain in the lower abdomen or pelvis of at least six months duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy＂. In addition, the condition is considered as a symptom, not a diagnosis. CPP is estimated to account for 10% of all referrals to gynecologists, 12% of all hysterectomies, and more than 40% of gynecologic diagnostic laparoscopies. The etiology is complex and may involve disorders of the reproductive tract,gastrointestinal tract, urinary tract, musculoskeletal system, and psychoneurological system. The diagnosis is often difficult, especially when nothing positive is found on physical examimation and imaging studies. The optimal management is usually difficult due to the unknown etiology.