Frequencies of interleukin-6, GST and progesterone receptor gene polymorphisms in postmenopausal women with low bone mineral density.

CONTEXT AND OBJECTIVE: Osteoporosis is a skeletal disorder characterized by low bone mineral density (BMD). Studies have shown that some of the genetic components relating to lower BMD may be detected by polymorphisms. Our aim was to evaluate the frequencies of interleukin-6, GST and progesterone receptor gene polymorphisms in postmenopausal women with low BMD. DESIGN AND SETTING: Cross-sectional study, conducted in a public university in São Paulo, Brazil. METHODS: We evaluated interleukin-6 (IL-6), progesterone receptor gene (PROGINS) and glutathione S-transferase (GST) polymorphisms in 110 postmenopausal women with no previous use of hormone therapy. Tests were performed using DNA-PCR, from oral scrapings. We used Student's t-test and a logistic regression model for statistical analysis. RESULTS: Regarding IL-6 polymorphism, 58.2% of the patients were homozygotes (GG) and 41.8% had allele C (heterozygote or mutant homozygote + GC or CC). PROGINS genotype polymorphism was absent in 79% (wild homozygote or P1/P1) and present in 20.9% (heterozygote or P1/P2). Regarding GSTM1 polymorphism, the allele (1/1) was present in 72.7% of the patients and was absent in 27.3%. We found that IL-6 polymorphism had statistically significant correlations with the L2-L4 T-score (P = 0.032) and with BMD (P = 0.005). Women with IL-6 polymorphism were 2.3 times more likely to have a L2-L4 T-score of less than -1, compared with those not presenting this polymorphism. CONCLUSION: IL-6 gene polymorphism was correlated with low BMD, whereas the PROGINS and GSTM1 polymorphisms did not show any correlation.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I.

OBJECTIVE: To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). MATERIALS AND METHODS: One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. RESULTS: There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. CONCLUSION: The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II.

OBJECTIVE: To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). MATERIALS AND METHODS: One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and ″de novo″ urinary symptoms after 12 months of surgery in both groups. RESULTS: Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and ″de novo ″ urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. CONCLUSION: There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and ″de novo ″ urinary symptoms between both groups after 12 months of surgery.

Sexual function after anterior vaginal wall prolapse surgery.

OBJECTIVE: The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy. METHODS: Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test. RESULTS: In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up. CONCLUSIONS: Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.

Prevalence of and quality of life related to anal incontinence in women with urinary incontinence and pelvic organ prolapse.

OBJECTIVE: To investigate the prevalence of anal incontinence (AI) in woman with urinary incontinence (UI) and pelvic organ prolapse (POP). We also evaluated the impact on quality of life (QoL). STUDY DESIGN: One hundred and ninety patients with UI or POP and 73 controls were recruited. AI was investigated by the Wexner index and the prevalence rates were obtained in all groups. Patients with AI completed the Fecal Incontinence Quality of Life questionnaire (FIQL). QoL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36). RESULTS: AI prevalence was 40.54% in the UI group and 27.91% in the POP group (p<0.0001). In the UI and POP groups correlations were found between the Wexner score and the domains of the FIQL and SF36. CONCLUSION: The UI group had higher prevalence of AI than the other groups. The AI adversely affected the QoL of patients.

Impact of birth in the presence and absence of simulated birth injury on vaginal glycosaminoglycan content.

INTRODUCTION AND HYPOTHESIS: This study aims to evaluate the effects of simulated birth trauma and vaginal and Cesarean delivery on glycosaminoglycans (GAGs) in the vagina of female rats. METHODS: One hundred ten rats were divided into six groups: A (control), B (vaginal trauma), C (Cesarean delivery), D (Cesarean delivery followed by vaginal trauma), E (vaginal delivery), and F (20th day of gestation). In each group, half of the animals were killed 4 days after the procedure (time 1) and 12 weeks later (time 2). GAGs were extracted, isolated, and identified by using agarose gel electrophoresis and quantified by densitometry. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: We observed a significant decrease in total GAGs and dermatan sulfate (DS) at time 1. Evaluation at time 2 showed a significant increase in total GAGs, DS, and heparan sulfate. CONCLUSIONS: Levels of sulfated GAGs in the rat vagina are affected by delivery and simulated birth trauma.

[Retropubic and transobturator sling in treatment of stress urinary incontinence].

OBJECTIVE: To compare the results of retropubic and transobturator slings for surgical treatment of female stress urinary incontinence (SUI). METHODS: We randomized thirty patients with SUI, ten of whom underwent transobturator sling surgery and ten retropubic sling surgery. Patients were assessed before treatment and 1, 6 and 12 months after treatment on the basis of clinical history, physical examination, quality of life questionnaire (King's Health Questionnaire), pad test and urodynamic evaluation. The groups were homogenous prior to surgery. RESULTS: One year after surgery, incontinence and quality of life parameters had improved significantly in both groups and there were no differences between them. There was a significant reduction in pad test weights in both groups. According to the urodynamic evaluation, 12 months after surgery cure rates were 84.2% for the transobturator group and 88.8% for the retropubic group. Subjective cure rates were 85% in the transobturator group and 88.8% in the retropubic group. No statistical difference was observed in complication rates. CONCLUSION: Retropubic and transobturator slings were effective for treatment of women with SUI at 12-month follow-up. Both techniques had significant cure rates and improved quality of life with low complication rates.

Analysis of glycosaminoglycans in the parametrium and vaginal apex of women with and without uterine prolapse.

BACKGROUND: Pelvic organ prolapse (POP) is a downward descent of pelvic organs that results in protrusions of the vagina, the uterus, or both. The cause of this disorder is likely to be multifactorial, attributable to a combination of risk factors, especially connective tissue disorders. Our objective was to characterize and quantify a component of the extracellular matrix (ECM)-sulfated glycosaminoglycan (GAG)-in the parametrium and vaginal apex of women with and without uterine prolapse. METHODS: Parametrium and vaginal apex tissue was obtained from 42 women who underwent surgery. Patients underwent a physical examination and were divided into groups according to the type of genital prolapse. Standard biopsies were taken during surgery and were assessed by biochemical methods. GAGs were obtained by proteolysis. The relative concentration of GAGs was determined by densitometry. Data were compared using an independent sample t-test or chi(2) test. RESULTS: In both groups (with and without prolapse) and in both types of tissue, dermatan sulfate (DS) was the most predominant glycosaminoglycan, followed by chondroitin sulfate (CS) and heparan sulfate (HS). We did not observe significant differences in the total amounts of GAGs, DS, CS, or HS. CONCLUSIONS: This study did not show altered biochemical characteristics in the ECM of parametrium and vaginal apex tissue of women either with or without uterine prolapse.

Anterior vaginal wall prolapse: a randomized controlled trial of SIS graft versus traditional colporrhaphy.

INTRODUCTION AND HYPOTHESIS: This study seeks to compare the small intestine submucosa (SIS) graft with traditional colporrhaphy (TC) for surgical treatment of anterior vaginal prolapse. METHODS: Subjects were randomly assigned to SIS (n = 29) or to TC (n = 27) preoperatively and outcomes analyzed at 12 months postoperatively. The primary outcome was the absence of POP-Q stage >or= II prolapse, and secondary outcome was improvement in quality of life. Data were compared with independent samples or paired Student's t test. RESULTS: SIS group had 86.2% anatomic cure compared to 59.3% in TC (p = 0.03). SIS improved point Ba measurement significantly (-1.93 cm versus -1.37 cm, p = 0.02). Both operations significantly improved quality of life, although there were no differences between the groups. We observed a greater number of complications in the SIS group, with no infections or erosion. CONCLUSIONS: SIS repair improved point Ba significantly. However, there were no differences observed in quality of life between the techniques.

Metabolic profile of glycosaminoglycans in bladder and urethra of female rats during and after pregnancy.

INTRODUCTION AND HYPOTHESIS: The objective of this study is to evaluate pregnancy's action on glycosaminoglycans (GAGs) profile in bladder and urethra of female adult rats. METHODS: Twenty adult female rats were divided into four groups: control, day 10 pregnancy, day 20 pregnancy, and day 5 after delivery. Sulfated GAGs content were determined by densitometry. Hyaluronic acid was assessed by fluorimetric enzyme-linked immunosorbent serologic-like assay. Radioactive GAGs were quantified by measuring radioactivity in electrophoresis gel. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: In all groups, dermatan sulfate was predominant followed by heparan sulfate and hyaluronic acid. Significant decrease in total GAGs in bladder was observed at the beginning of pregnancy, with progressive increase. Biosynthesis of such molecules showed a similar behavior. In urethra, changes in GAGs content were restricted to the end of pregnancy. Hyaluronic acid content showed a significant increase in bladder during puerperium. CONCLUSIONS: We observed different composition in vesical and urethral tissues during pregnancy and in puerperium.

Impact of HTLV-I in quality of life and urogynecologic parameters of women with urinary incontinence.

OBJECTIVE: To assess the impact of urinary incontinence in quality of life, epidemiological data, symptoms, findings of gynecological/neurological examination and urodynamic of HTLV-I seropositive women compared with HTLV-I negative women. STUDY DESIGN: 43 incontinent women were divided in two groups: 24 seropositives and 19 seronegatives for HTLV-I. We used King's Health Questionnaire (KHQ), standardized recorded data and urodynamics. Data were compared using Mann-Whitney test or Chi-squared test. RESULTS: Quality of life was significantly worse in seropositive incontinent women in the following parameters: general perception of health, impact of incontinence, limitation of daily life activities, social relations, sleep and disposition. Also, the following gynecological/neurological symptoms were more prevalent in seropositives: pain on vesical filling, dyspareunia, parestesis in inferior members, increased perineal sensitivity, pain in vaginal palpation, increased vaginal tonus, gait alteration, increased patellar reflex, Babinski reflex positive and increased tonus in inferior members. CONCLUSION: Poor quality of life and physical abnormalities were identified in incontinent HTLV-I seropositive women when compared with incontinent HTLV-I seronegative women.

Sulfated glycosaminoglycans of periurethral tissue in pre- and postmenopausal women.

OBJECTIVE: The objective was to determine the sulfated glycosaminoglycans (GAGs) of the extracellular matrix (ECM) in pre- and postmenopausal women. STUDY DESIGN: Periurethral tissue was obtained from 44 consecutive women who underwent surgery for urinary incontinence, for pelvic organ prolapse, or for other gynecologic benign conditions. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated GAG. Measurements were made of total GAG, chondroitin sulfate, dermatan sulfate and of heparan sulfate. Data were compared using the t-test. RESULTS: Patients were divided into two groups (pre- and postmenopausal groups) and dermatan sulfate was the most predominant glycosaminoglycan. Postmenopausal women had significantly less total sulfated glycosaminoglycans (p<0.01), dermatan sulfate (p<0.01) and chondroitin sulfate (p<0.05) than premenopausal women. We did not observe any differences in heparan sulfate. CONCLUSIONS: Postmenopausal women showed quantitative differences in the biochemical characteristics of the ECM in periurethral tissue by analysis of sulfated GAG.

[Evaluation of glycosaminoglycans of periurethral tissue in patients with and without pelvic organ prolapse]. / Avaliação dos glicosaminoglicanos do tecido periuretral de pacientes com e sem prolapso genital.

OBJECTIVE: To characterize and quantify periurethral tissue sulphated glycosaminoglycans (GAGs) in women with and without pelvic organ prolapse. STUDY DESIGN: Periurethral tissue was obtained from 35 women who underwent surgery for pelvic organ prolapse, for stress urinary incontinence, or for other gynecological benign conditions. Patients were submitted to a clinical history, physical and urodynamic examination and were divided in two groups according to genital prolapse. The standard biopsy with 1.0 x 1.0 cm was taken from periurethral tissue during surgery and assessed by biochemical methods. The GAGs were obtained by proteolysis and precipitated by trichloroacetic acid. The relative concentration of sulfated GAGs was determined by densitometry of toluidine blue stained gel using a spectrophotometer with a 525 nm wavelength. Data were compared using analysis of variance (ANOVA). RESULTS: In the two groups dermatan sulphate (DS) was the predominant glycosaminoglycan (85%), followed by chondroitin sulphate (CS) and heparan sulphate (HS). Women with pelvic organ prolapse had significantly more total GAGs, DS and HS. Differences in CS were not observed. CONCLUSIONS: This study showed altered biochemical characteristics in the extracellular matrix of periurethral tissue and also accumulation of GAGs, DS and CS, in women with pelvic organ prolapse.

Sulfated glycosaminoglycans of the periurethral tissue in women with and without stress urinary incontinence, according to genital prolapse stage.

OBJECTIVE: The objective was to determine sulfated glycosaminoglycans (GAG) of the extracellular matrix (ECM) in women with and without stress urinary incontinence according to genital prolapse stage. STUDY DESIGN: Periurethral tissue was obtained from 30 women who underwent surgery for urinary incontinence, for pelvic organ prolapse, or for other benign gynecologic conditions. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated glycosaminoglycans. Measurements were made of total glycosaminoglycans, chondroitin sulfate, dermatan sulfate, and of heparan sulfate. Data were compared using the t-test. RESULTS: In two groups, dermatan sulfate was the most predominant glycosaminoglycan. Women with stress urinary incontinence had significantly more total sulfated glycosaminoglycans (p<0.05) and dermatan sulfate (p<0.05) than women without stress urinary incontinence. We did not observe any differences in chondroitin sulfate and heparan sulfate. CONCLUSIONS: Women with stress urinary incontinence showed quantitative and qualitative differences in the biochemical characteristics of the extracellular matrix in periurethral tissue by analysis of sulfated glycosaminoglycans, according to genital prolapse stage.

Correlation between valsalva leak point pressure and maximal urethral closure pressure in women with stress urinary incontinence.

This study analyzed the relationship between valsalva leak point pressure (VLPP) and maximal urethral closure pressure (MUCP) in women with stress urinary incontinence. One hundred sixty-one patients were selected with diagnosis of mixed or stress urinary incontinence. During urodynamics we measured VLPP and MUCP. Patients were gathered according to VLPP and analysis of variance (ANOVA) was performed. Pearson's correlation coefficient and linear regression were also utilized. The group with VLPP under 60 cm H(2)O had mean MUCP of 44.5 cm H(2)0; the group with VLPP between 60 and 90 cm H(2)O had mean MUCP of 54.3 cm H(2)O; and the group with VLPP over 90 cm H(2)O had mean MUCP of 60.1 cm H(2)O. We observed correlation between MUCP and VLPP when we used Pearson's correlation coefficient (r=0.22) and linear regression ( p<0.05). There was weak correlation between MUCP and VLPP, and MUCP was significantly lower in patients with leak point pressure inferior to 60 cm H(2)O.