The study was undertaken to assess the results of the sacrospinous colpopexy procedure for the treatment of vault prolapse following hysterectomy. It was also to assess the results of the procedure in the treatment of marked uterovaginal prolapse and to compare its role in a group undergoing hysterectomy with a group in whom the uterus was conserved. A prospective study was undertaken between December 1991 and December 1992. Forty women with vm1lt prolapse following hysterectomy were included in one group. All these patients underwent posterior vaginal repair, enterocele sac obliteration and sacrospinous colpopexy. In 25 patients an anterior vaginal repair with sub urethral buttressing sutures was also perfom1ed. A long-needle bladder neck suspension operation was included for three women with coexistent stress incontinence. The mean follow-up period was six months. The success rate was 92%. Of the three failures one underwent a successful repeat sacrospinous colpopexy and repair. The main long-term complication was cystocele formation. A further 24 women with marked uterovaginal prolapse were also included. All women underwent anterior and posterior vaginal repairs, enterocele sac obliteration and sacrospinous ligament fixation. In 13 patients a vaginal hysterectomy was performed and in 11 the uterus was conserved. In the hysterectomy group the follow-up was four months. Although there have been no failures, one woman had developed a small asymptomatic cystocele. Follow-up in the group with uterine preservation was three and a half months. A gain, no failures were seen but three women had developed small asymptomatic cystoceles. There were no differences between the groups apart from a significantly shorter operating time in the patients who did not undergo hysterectomy. The sacrospinous colpopexy is effective in the treatment of vault prolapse. It avoids major abdominal surgery: and allows the surgeon to correct coexistent cystocele and rectocele. The procedure is a useful adjuvent to vaginal repair for marked degrees of uterovaginal prolapse, resulting in a well-supported vagina in the correct anatomical position.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Liu Yuet Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 165-191). / Abstracts in English and Chinese. / Acknowledgement --- p.i / Abstract --- p.iii / Abbreviations --- p.vi / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Incidences and Prevalence --- p.2 / Chapter 1.2 --- Anatomy of Uterus and its Support Mechanism --- p.3 / Chapter 1.3 --- Pathophysiology of Uterine Prolapse --- p.5 / Chapter 1.4 --- Classification of Uterine Prolapse --- p.6 / Chapter 1.5 --- Etiology of Uterine Prolapse --- p.7 / Chapter 1.6 --- Treatment of Uterine Prolapse --- p.12 / Chapter 1.6.1 --- Conservative Treatment --- p.12 / Chapter 1.6.2 --- Surgical Treatment --- p.13 / Chapter 1.7 --- Molecular Basis of Uterine Prolapse --- p.14 / Chapter 1.7.1 --- Collagen Metabolism --- p.15 / Chapter 1.7.2 --- Extracellular Matrix Metabolism --- p.16 / Chapter 1.7.3 --- Advanced Glycation End-products --- p.18 / Chapter 1.7.4 --- Estrogen and Estrogen Receptors --- p.19 / Chapter 1.8 --- Gene Expression Profiling of Uterine Prolapse --- p.22 / Chapter 1.9 --- Microarray Gene Expression Profiling Analysis --- p.24 / Chapter 1.9.1 --- Types of Microarray --- p.26 / Chapter 1.9.2 --- Comparison of Oligonucleotide and cDNA Arrays --- p.31 / Chapter 1.10 --- Quantitative Real-time PCR --- p.32 / Chapter 1.10.1 --- Principle of TaqMan Real-time PCR --- p.32 / Chapter 1.10.2 --- Other Types of Real-time PCR --- p.33 / Chapter 1.11 --- Project Aims --- p.34 / Chapter 1.12 --- Significance of Study --- p.35 / Chapter CHAPTER 2 --- MATERIALS AND METHODS --- p.37 / Chapter 2.1 --- Materials --- p.37 / Chapter 2.1.1 --- Patients --- p.37 / Chapter 2.1.2 --- Cardinal Ligament Specimen --- p.38 / Chapter 2.2 --- Methods --- p.39 / Chapter 2.2.1 --- Homogenization of Cardinal Ligament Tissues --- p.39 / Chapter 2.2.2 --- Total RNA extraction --- p.39 / Chapter 2.2.3 --- Oligonucleotide Microarray --- p.41 / Chapter 2.2.3.1 --- Two-cycle cDNA Synthesis --- p.41 / Chapter 2.2.3.2 --- Cleanup of Double-stranded cDNA --- p.45 / Chapter 2.2.3.3 --- Synthesis of Biotin-labeled cRNA --- p.45 / Chapter 2.2.3.4 --- Cleanup and Quantification of Biotin-labeled cRNA --- p.46 / Chapter 2.2.3.5 --- Fragmenting the cRNA for Target Preparation --- p.47 / Chapter 2.2.3.6 --- Target Hybridization --- p.47 / Chapter 2.2.3.7 --- "Array Washing, Staining and Scanning" --- p.48 / Chapter 2.2.3.8 --- Statistical Analysis of Microarray Data --- p.49 / Chapter 2.2.4 --- Quantitative Real-time Polymerase Chain Reaction --- p.52 / Chapter 2.2.4.1 --- Primers and Probes --- p.52 / Chapter 2.2.4.2 --- Reverse Transcription --- p.53 / Chapter 2.2.4.3 --- Plate Setup --- p.53 / Chapter 2.2.4.4 --- Real-time PCR Reaction Mixture Setup --- p.54 / Chapter 2.2.4.5 --- Statistical Analysis of Real-time PCR Data --- p.54 / Chapter CHAPTER 3 --- RESULTS --- p.56 / Chapter 3.1 --- Microarray Gene Expression Data Analysis --- p.57 / Chapter 3.1.1 --- Unsupervised Gene Selection --- p.57 / Chapter 3.1.2 --- Supervised Gene Selection --- p.59 / Chapter 3.1.2.1 --- Gene Expression Profiles Distinguish Cardinal Ligament with Uterine Prolapse from Control and Identify Differentially Expressed Genes --- p.59 / Chapter 3.1.2.2 --- Gene Expression Profiles Distinguish Cardinal Ligament with Different Degrees of Uterine Prolapse from Control and Identify Differentially Expressed Genes --- p.72 / Chapter 3.1.2.3 --- Gene Expression Profiles Distinguish Cardinal Ligament with Third-degree Prolapse from First-degree Prolapse and Identify Differentially Expressed Genes --- p.92 / Chapter 3.2 --- Validation of Microarray Data by Quantitative Real-time PCR --- p.96 / Chapter 3.2.1 --- Fold Change of Candidate Genes --- p.97 / Chapter 3.2.2 --- Correlation Between Microarray and Quantitative Real-time PCR Results --- p.102 / Chapter CHAPTER 4 --- DISCUSSIONS --- p.103 / Chapter 4.1 --- Global Gene Expression Profiling using Oligonucleotide Microarray --- p.103 / Chapter 4.1.1 --- Advantages of using Affymetrix GeneChipR Microarray for Gene Expression Profiling --- p.103 / Chapter 4.1.2 --- Microarray analysis software --- p.105 / Chapter 4.1.2.1 --- DNA-Chip Analyzer Software --- p.105 / Chapter 4.1.2.2 --- Comparison of Statistical Methods for Analysis of A ffymetrix GeneChipRMicroarray Data --- p.108 / Chapter 4.2 --- Validation of Microarray Data --- p.111 / Chapter 4.2.1 --- Advantages of using Quantitative Real-time PCR for mRNA Quantification --- p.111 / Chapter 4.3 --- Microarray Gene Expression Data Analysis --- p.115 / Chapter 4.3.1 --- Unsupervised Gene Selection --- p.115 / Chapter 4.3.2 --- Supervised Gene Selection --- p.115 / Chapter 4.3.2.1 --- Gene Expression Profiles Distinguish Cardinal Ligament with Uterine Prolapse from Control and Identify Differentially Expressed Genes --- p.115 / Chapter 4.3.2.2 --- Gene Expression Profiles Distinguish Cardinal Ligament with Different Degrees of Uterine Prolapse from Control and Identify Differentially Expressed Genes --- p.118 / Chapter 4.3.2.3 --- Gene Expression Profiles Distinguish Cardinal Ligament with Third-degree Prolapse from First-degree Prolapse and Identify Differentially Expressed Genes --- p.120 / Chapter 4.4 --- Potential Genes for Further Studies in Uterine Prolapse --- p.120 / Chapter 4.5 --- Implications of This Study --- p.157 / Chapter 4.6 --- Limitations of This Study --- p.160 / Chapter CHAPTER 5 --- CONCLUSIONS --- p.162 / Chapter CHAPTER 6 --- FUTURE PROSPECT --- p.164 / REFERENCES --- p.165

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

O prolapso uterino tem sua incidência aumentada na pós-menopausa. O objetivo deste estudo é identificar as alterações na matriz extracelular do ligamento cardinal associadas à menopausa e ao prolapso uterino. Ligamento cardinal de três diferentes grupos de mulheres, pré-menopausa, prolapso uterino e pós-menopausa, foram identificados e biopsiados durante 57 histerectomias abdominais ou vaginais. As amostras foram processadas por métodos bioquímicos para caracterização e quantificação de glicosaminoglicanos sulfatados e colágeno. As concentrações relativas de glicosaminoglicanos foram obtidas por eletroforese. Procedimentos histológicos foram feitos para identificar fibras elásticas (Weigert), distribuição de colágeno (Picro Sirius) e decorin (imunohistoquímica). Nossos resultados mostraram aumento na concentração de GAG de 72,2%, redução na concentração de colágeno de 37% e diminuição de 22% de fibras elásticas no grupo de prolapso uterino quando comparado ao grupo da pós-menopausa (p<0,05, p<0,04 e p<0,05 respectivamente). As concentrações relativas de glicosaminoglicanos sulfatados para condroitin sulfato, heparan sulfato e dermatan sulfato não mostraram diferenças entre os três grupos. A organização do colágeno foi similar entre os três grupos e a marcação do decorin pareceu estar diminuída no grupo de prolapso uterino. Nossos resultados indicam alterações no metabolismo do tecido conjuntivo. O ligamento cardinal da mulher na pós-menopausa possui uma matriz extracelular mais densa. Esta alteração não ocorre na mulher com prolapso uterino. / Uterine prolapse has increase of incidence after menopause. The aim of this study was to identify the changes in extracellular matrix of cardinal ligaments associated to menopause and uterine prolapse. Cardinal ligament of 3 different groups (pre-menopause, menopause and uterine prolapse) are identified and biopsied during 57 womens abdominal or vaginal hysterectomy. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated glycosaminoglycans and collagen. Relative concentrations of GAG were obtained by electrophoresis. Histological procedures are made to identify elastic fibers (Weigert) collagen distribution (Picro sirius) and decorin (immunohistochemistry). Our results showed increase in GAG concentration 72.2% in uterine prolapse group compared to menopause group (p<0.05). Collagen concentration was 37% lower in uterine prolapse group compared to menopause group (p<0.04). Relative concentration of GAG: heparan sulfate, chondroitin sulfate and dermatan sulfate showed no differences among three groups. Elastic fibers showed a significant reduction of approximately 22% uterine prolapse group compared to menopause group (p<0.05). Collagen organization was similar in three groups and the staining pattern of decorin seemed to be decreased in uterine prolapse group. Our results indicate changes in connective tissue metabolism. Cardinal ligament in postmenopausal women has a denser extracellular matrix. This change is not observed in women with uterine prolapse.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

O prolapso uterino tem sua incidência aumentada na pós-menopausa. O objetivo deste estudo é identificar as alterações na matriz extracelular do ligamento cardinal associadas à menopausa e ao prolapso uterino. Ligamento cardinal de três diferentes grupos de mulheres, pré-menopausa, prolapso uterino e pós-menopausa, foram identificados e biopsiados durante 57 histerectomias abdominais ou vaginais. As amostras foram processadas por métodos bioquímicos para caracterização e quantificação de glicosaminoglicanos sulfatados e colágeno. As concentrações relativas de glicosaminoglicanos foram obtidas por eletroforese. Procedimentos histológicos foram feitos para identificar fibras elásticas (Weigert), distribuição de colágeno (Picro Sirius) e decorin (imunohistoquímica). Nossos resultados mostraram aumento na concentração de GAG de 72,2%, redução na concentração de colágeno de 37% e diminuição de 22% de fibras elásticas no grupo de prolapso uterino quando comparado ao grupo da pós-menopausa (p<0,05, p<0,04 e p<0,05 respectivamente). As concentrações relativas de glicosaminoglicanos sulfatados para condroitin sulfato, heparan sulfato e dermatan sulfato não mostraram diferenças entre os três grupos. A organização do colágeno foi similar entre os três grupos e a marcação do decorin pareceu estar diminuída no grupo de prolapso uterino. Nossos resultados indicam alterações no metabolismo do tecido conjuntivo. O ligamento cardinal da mulher na pós-menopausa possui uma matriz extracelular mais densa. Esta alteração não ocorre na mulher com prolapso uterino. / Uterine prolapse has increase of incidence after menopause. The aim of this study was to identify the changes in extracellular matrix of cardinal ligaments associated to menopause and uterine prolapse. Cardinal ligament of 3 different groups (pre-menopause, menopause and uterine prolapse) are identified and biopsied during 57 womens abdominal or vaginal hysterectomy. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated glycosaminoglycans and collagen. Relative concentrations of GAG were obtained by electrophoresis. Histological procedures are made to identify elastic fibers (Weigert) collagen distribution (Picro sirius) and decorin (immunohistochemistry). Our results showed increase in GAG concentration 72.2% in uterine prolapse group compared to menopause group (p<0.05). Collagen concentration was 37% lower in uterine prolapse group compared to menopause group (p<0.04). Relative concentration of GAG: heparan sulfate, chondroitin sulfate and dermatan sulfate showed no differences among three groups. Elastic fibers showed a significant reduction of approximately 22% uterine prolapse group compared to menopause group (p<0.05). Collagen organization was similar in three groups and the staining pattern of decorin seemed to be decreased in uterine prolapse group. Our results indicate changes in connective tissue metabolism. Cardinal ligament in postmenopausal women has a denser extracellular matrix. This change is not observed in women with uterine prolapse.

Orientador: Viviane Herrmann Rodrigues / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T03:27:58Z (GMT). No. of bitstreams: 1 Castro_EdilsonBeneditode_M.pdf: 1738241 bytes, checksum: ddc9c76f04b9f7476ede4b0a887d468a (MD5) Previous issue date: 2006 / Resumo: Objetivos: Avaliar pelo sistema de quantificação do prolapso dos órgãos pélvicos (POP-Q), preconizado pela Sociedade Internacional de Continência (ICS) os compartimentos vaginais anterior, posterior e apical em mulheres submetidas à colpofixação sacroespinhal para o tratamento do prolapso uterino ou de cúpula vaginal e analisar os sintomas urinários antes e depois da cirurgia. Sujeitos e métodos: Estudo retrospectivo realizado no Setor de Uroginecologia do Hospital Estadual Sumaré da Universidade Estadual de Campinas em 2006. Foram analisados os prontuários de 47 mulheres submetidas à colpopexia sacroespinhal entre março de 2003 e fevereiro de 2006. Foram avaliados os sintomas urinários (incontinência urinária de esforço, urgência, incontinência de urgência, noctúria e enurese noturna) no pré e pós-operatório, considerando-se sintomas presentes ou ausentes e analisados pelo Teste de qui-quadrado de Mc Nemar. Os pontos Aa, Ba, C, D, Ap, Bp, tvl, gh e pb do POP-Q foram avaliados na primeira consulta e na revisão pós-operatória. O Teste de Wilcoxon foi aplicado para comparar os pontos e os estágios do prolapso genital antes e depois da cirurgia. Complicações intra e pós-operatórias foram descritas. Resultados: A média dos pontos do POP-Q no pré e pós-operatório foi respectivamente: Aa (+0,7; -1,7); Ba (+3,2; -1,7); C (+3,2; -7,6); Ap (-0,2; -2,7) e Bp (+2,1; -2,7) (p<0.001). A taxa de cura foi 97,9% para o prolapso apical. Avaliação pré e pós-operatória do compartimento vaginal anterior foi respectivamente: estágio 1 (4,3%; 57,4%), estágio 2 (8,5%; 31,9%), estágio 3 (76,6%; 0%) e estágio 4 (10,6%; 0%). Cistocele ocorreu em 89,4% no pós-operatório. Onze de 12 mulheres que apresentavam urgência miccional tiveram melhora após a cirurgia (p=0,0039) e uma das 45 que não tinham a queixa passou a apresentá-la. Das 8 pacientes que se queixavam de incontinência de urgência, 7 apresentaram remissão do sintoma após a cirurgia (p=0,0082). Houve melhora da noctúria em 7 de 8 casos após a cirurgia (p=0,0399) e 1 dos 39 casos que eram assintomáticos desencadeou o sintoma no pós-operatório. Conclusão: A colpofixação sacroespinhal é um método eficiente para o tratamento do prolapso apical e de parede posterior levando, porém 89,4% das pacientes a apresentarem prolapso de parede anterior estágio 1 e 2 devido ao desvio posterior do eixo vaginal. Ocorreu melhora dos sintomas urinários irritativos (urgência, incontinência de urgência e noctúria) nas pacientes submetidas à fixação sacroespinhal da cúpula vaginal pelo restabelecimento do sistema de sustentação apical posterior / Abstract: Objectives: To evaluate the extent of prolapse of the anterior, posterior and apical vaginal compartments in women undergoing sacrospinous ligament fixation using the pelvic organ prolapse quantification system (POP-Q), recommended by the International Continence Society (ICS) for the treatment of uterine and vaginal vault prolapse and examine urinary symptoms before and after surgery. Subjects and methods: A study was conducted in the Urogynecology Sector of the Sumaré Municipal Hospital of the Universidade Estadual de Campinas in 2006. Medical charts of 47 women undergoing sacrospinous colpopexy between March 2003 and February 2006 were assessed. Urinary symptoms (stress urinary incontinence, urgency, incontinence of urgency, nocturia and nocturnal enuresis) were evaluated in the preoperative and postoperative period, categorizing symptoms as present or absent, and applying the Mc Nemar chi-square test for analysis. Aa, Ba, C, D, Ap, Bp, tvl, gh and pb points of POP-Q were evaluated in the first consultation and postoperative revision. Wilcoxon?s test was applied to compare points and stages of genital prolapse before and after surgery. Intraoperative and postoperative complications were described. Results: Mean POP-Q points in the preoperative and postoperative period were, respectively: Aa (+0.7; -1.7); Ba (+3.2; -1.7); C (+3.2; -7.6); Ap (-0.2; -2.7) and Bp (+2.1; -2.7) (p<0.001). The cure rate was 97.9% for apical prolapse. Preoperative and postoperative evaluation of the anterior vaginal compartment was, respectively: stage 1 (4.3%; 57.4%), stage 2 (8.5%; 31.9%), stage 3 (76.6%; 0%) and stage 4 (10.6%; 0%). Cystocele occurred in 89.4%. Eleven of 12 women with mictional urgency showed improvement of symptom after surgery (p=0.0039) and one of the 45 patients who had no previous complaint, started to suffer from the symptom. Of 8 patients whose complaint was incontinence of urgency, 7 had remission of symptom after surgery (p=0.0082). Nocturia improved in 7 out of 8 cases after surgery (p=0.0399) and the symptom was triggered postoperatively in 1 out of 39 asymptomatic women. Conclusion: Sacrospinous ligament fixation is an efficient method for the treatment of apical and posterior wall prolapse, despite leading to stage 1 and 2 anterior wall prolapse in 89.4% of women due to posterior deviation of the vaginal apex. Improvement in irritative urinary symtoms (urgency, incontinence of urgency and nocturia) took place in patients undergoing sacrospinous ligament fixation of the vaginal vault by reconstitution of the posterior apical support system / Mestrado / Cirurgia / Mestre em Cirurgia

No description available.

Foram estudados, prospectivamente, por um período médio de 4,9 anos, os resultados do tratamento de 31 mulheres com incontinência urinária e afecção benigna do útero que foram submetidas à cirurgia de sling fascial associada à histerectomia vaginal, atendidas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de fevereiro de 2000 a outubro de 2006. O objetivo foi avaliar os resultados do tratamento comparando-se os diagnósticos urodinâmicos pré- e pós-tratamento. As mulheres foram submetidas à cirurgia de histerectomia vaginal, para tratamento da afecção benigna do útero e sling fascial para correção da incontinência urinária. Realizou-se estudo urodinâmico no pré- e pós-tratamento, para avaliação da taxa de cura da incontinência urinária e do comportamento vesical nas fases de enchimento e esvaziamento, os quais foram avaliados por meio dos parâmetros urodinâmicos de fluxometria e cistometria. Na fluxometria avaliou-se o fluxo urinário máximo, fluxo urinário médio e volume de urina residual e na cistometria, determinou-se a capacidade vesical no 1° desejo miccional, capacidade vesical máxima e a pressão vesical necessária para ocorrer ou não a perda de urina. Os resultados mostraram, em relação á fluxometria diminuição significante do fluxo máximo, tendência à diminuição do fluxo médio e redução significante do volume de urina residual. Em relação à cistometria, houve aumento estatisticamente significante da capacidade vesical no 1° desejo miccional, da capacidade vesical máxima e valor da pressão vesical necessária para avaliar a presença ou não de perda urinária. Com relação ao diagnóstico urodinâmico, foi demonstrada a cura da incontinência urinária em 96,8% dos casos. Avaliando-se os parâmetros de cura objetiva da incontinência urinária, em seguimento de 4,9 anos, podemos inferir que o tratamento da incontinência urinária de esforço pode ser realizado simultaneamente, quando houver também, a indicação de histerectomia vaginal / We studied, prospectively, for a 4.9 years period the results of the treatment of 31 women with urinary incontinence and benign uterine disease that were submitted the surgery fascial sling associated to vaginal hysterectomy, the patients were all treated in the Gynecology Department of the Clinic Hospital of the University of Sao Paulo, in the period between February 2000 to October 2006. The objective was evaluate the results of the treatment comparing the urodinamic diagnosis pre and post treatment. All women were submitted to vaginal hysterectomy for treatment of benign uterine disorders and to facial sling to treat the urinary incontinence. An urodinamic study was performed pre and post treatment to define the rate of cure of the urinary incontinence and vesical behaviour in the filling and emptying fases, witch will evaluate through urodinamic parameters of flowmetry and cystometry, In the flowmetry were evaluated maximum urinary flow, medium urinary flow and residual urinary volume; and in the cystometry were determinated the bowel capacity in the first urinary desire, maximum bowel capacity in the first urinary desire, maximum bowel capacity and the needed bowel pressure to occur or not the urinary loss. The results showed in relation to the flowmetry significant reduction of the maximum flow, medium flow and urinary residual volume. In relation to cystometry we demonstrated an increase statistically significant in the vesical capacity in the first miccional desire, in the maximum bowel capacity and the value of the bowel pressure to evaluate the presence or not of urinary lost. In relation to the urodimanic diagnosis we could demonstrate the cure of urinary incontinence in 96.8% of cases. Evaluating the parameters of objective cure of urinary incontinence, in a follow up of 4.9 years, we can affirm that the treatment of urinary incontinence should be always be together with the vaginal hysterectomy when it is needed