Expression of estrogen receptors in the pelvic floor of pre- and post-menopausal women presenting pelvic organ prolapse.

The precise role of estrogen in the pathogenesis of pelvic organ prolapse (POP) is still unclear, while the results concerning the effect of selective estrogen receptor modulators on pelvic organ prolapse are contradictory. Our aim was to test whether alteration in the expression of estrogen receptors in the pelvic floor of pre- and post-menopausal women is related to genital prolapse status. The mRNA levels of ERα and ERß in 60 biopsy specimens were measured. Significantly higher expression of ERα and higher ERα/ERß ratio were demonstrated in post-menopausal women compared to pre-menopausal women. Higher expression of ERα and higher ERα/ERß ratio were detected in all studied groups with POP, thus it did not reach significance in the post-menopausal group. Pre-menopausal and post-menopausal women presenting pelvic organ prolapse had no difference in the ERα expression. Our preliminary study may indicate that pelvic organ prolapse is associated with higher expression of ERα/ERß in the pelvic floor of both pre- and post-menopausal women; thus not reaching statistical significance in the post-menopausal women was probably due to the group's size. We believe that the inevitable changes in the estrogen receptor expression over women's different lifetimes may affect the risk of genital prolapse progression, and might contribute to the further search for appropriate selective estrogen receptor modulators as a treatment for women with pelvic organ prolapse.

Cystocele repair by transobturator four arms mesh: monocentric experience of first 123 patients.

INTRODUCTION AND HYPOTHESIS: The aims of the study were to evaluate the per- and post-operative complications and outcomes after cystocele repair with transobturator mesh. METHODS: A retrospective continuous series study was conducted over a period of 3 years. Clinical evaluation was up to 1 year with additional telephonic interview performed after 34 months on average. When stress urinary incontinence (SUI) was associated with the cystocele, it was treated with the same mesh. RESULTS: One hundred twenty-three patients were treated for cystocele. Per-operative complications occurred in six patients. After 1 year, erosion rate was 6.5%, and only three cystoceles recurred. After treatment of SUI with the same mesh, 87.7% restored continence. Overall patient's satisfaction rate was 93.5%. CONCLUSIONS: Treatment of cystocele using transobturator four arms mesh appears to reduce the risk of recurrence at 1 year, along with high rate of patient's satisfaction. The transobturator path of the prosthesis arms seems devoid of serious per- and post-operative risks and allows restoring continence when SUI is present.

Prenatal diagnosis of a fibrosarcoma of the thigh: a case report.

We report a rare case of fibrosarcoma of the thigh suspected prenatally. At 27 weeks of gestation a voluminous, vascularised mass was discovered at ultrasound on the foetus' left leg, suggestive of haemangioma or a fibrosarcoma. There were no signs of heart failure. A rapid increase in the tumour mass was noted and a caesarean section was carried out at 39 weeks because of abnormal foetal heart rate. Postnatal ultrasound examination was comparable to that carried out prenatally; pathological examination of the mass biopsied and immunohistochemical investigation provided a diagnosis of congenital fibrosarcoma. After neoadjuvant chemotherapy and surgery the infant is now in complete remission without amputation.