A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse.

BACKGROUND: It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011. METHODS: A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided). RESULTS: The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107). CONCLUSIONS: The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly. TRIAL REGISTRATION NUMBER: NCT03620565, https://register.clinicaltrials.gov.

[Study on the relationship between polymorphism sites of IL-10 and the susceptibility of endometriosis].

OBJECTIVE: To explore the relationship of the endometriosis susceptibility and polymorphism of up stream of IL-10 promoter at the site of 1082(G→A), 819(C→T) and 592(C→A). METHODS: A total of 214 patients with endometriosis and 160 healthy individuals were enrolled and divided into patient group and control group in this study. The polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) was applied to detect the base transition in the up stream of IL-10 promoter at the site of 1082(G→A), 819(C→T) and 592(C→A). SPSS11.0 software was applied to analysis frequencies of all genotypes. RESULTS: There was no difference in polymorphism of IL-10-1082 between the endometriosis (AA: 87.90%, GA: 12.10%) and control group (AA: 87.50%, GA: 12.50%). The rate of TT, CT and CC genotype IL-10-819 was the same as the AA, CA and CC individually. There was no difference in the polymorphism of IL-10-819 or IL-10-592 between the endometriosis group (TT or AA: 41.12%, CT or CA: 47.66%, CC: 11.21%) and control group (χ(2) = 5.87, P = 0.053). However, there were significant difference in the genotype of CT of IL-10-819 or CA of IL-10-592 between the endometriosis group and control group (after adjust OR = 1.88, 95% CI = 1.10 - 3.21, χ(2) = 5.24, P = 0.021), and the allele C of IL-10-819 or IL-10-592 were close related with occurrence of endometriosis (OR = 1.42, 95%CI = 1.04 - 1.95, χ(2) = 4.81, P = 0.028). The IL-10 level in the plasma of endometriosis group with genotype of CC (CC), CT (CA) of IL-10-819(-592) were significant higher than those with TT (AA) (CA/CT: (50.12 ± 82.40) pg/ml, CC: (91.00 ± 118.23) pg/ml, TT/AA: (21.45 ± 22.10) pg/ml) (F = 2.492, P = 0.048; F = 1.852, P = 0.008). CONCLUSION: The allele C of IL-10-819 or IL-10-592 was close related to the high level expression of IL-10, and it is the risk of the occurrence of endometriosis.

[Changes of collagen content in uterine ligaments of perimenopausal women with relaxation of pelvic supports].

OBJECTIVE: To investigate the changes in histological characteristics and collagen content in uterosacral and cardinal ligaments of perimenopausal women in relation to relaxation of pelvic supports. METHODS: Twenty-eight subjects undergoing hysterectomies were selected, in which 14 cases were perimenopausal women with relaxation of pelvic support as the relaxation group and 14 women at perimenopausal age with leomyoma, cervical cancer, adenomyosis as the control group. Samples of cardinal ligaments and uterosacral ligaments were obtained at hysterectomies, and the tissues were sliced and stained by Masson's trichrome technique. Histological characteristics of the samples were studied and immunohistochemistry assay was applied to demonstrate the contents of collagen types I and III. RESULTS: (1) The collagen in uterosacral ligaments and cardinal ligaments were stained blue by the Masson's trichome technique. In comparison to the control group, the relaxation group had milder positive stains of the collagen and the stains were distributed in unequal intensities. Collagen content was arranged in loose pattern. Focal arrangement of the collagen was dense but fragmented. Collagen fibers were atrophic. (2) In immunohistochemistry assay and image analysis, collagen was positive in light to deep brown areas. In the relaxation group, positive units of collagen types I and III in cardinal ligaments were 13.8 +/- 2.1 and 9.6 +/- 2.4 respectively. Positive units of collagen types I and III of cardinal ligaments in the control group were 27.4 +/- 3.5 and 17.7 +/- 4.0 respectively. Differences between these two groups were statistically significant (P<0.01). In the relaxation group, positive units of collagen types I and III in utero-sacral ligaments were 15. 8 +/- 2.5 and 10.3 +/- 3.6 respectively. Positive units of collagen types I and III of utero-sacral ligaments of the control group were 29.5 +/- 4.4 and 19.3 +/- 4.6 respectively. Differences between these two groups were statistically significant (P<0.01). CONCLUSIONS: Reductions in collagen types I and III occur in pelvic floor tissue of perimenopausal patients who suffer from pelvic support relaxation. Atrophic and degenerative changes of collagen fibers may be the basic pathological structural alteration in pelvic floor.