Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aims of the study Urodynamic studies (UDS) have been suggested to be performed as part of the pre-operative work-up of patients undergoing prolapse surgery. Some women with POP have occult stress urinary incontinence (OSUI) and even if subjectively continent, have a higher incidence of developing de novo stress urinary incontinence (SUI). The aim of this study was to describe the outcome of a group of patients who had pre-operative UDS and manual prolapse reduction. Methods This was a retrospective descriptive study including all women who had prolapse surgery during the period January 2006 to December 2011. Patients received routine pre-operative UDS and manual reduction of prolapse, performed at maximum bladder capacity determined by UDS. Patients demonstrating urodynamic SUI or OSUI were offered a concomitant anti-incontinence procedure. Post-operative follow-up data included symptoms of SUI and clinical evidence of SUI. Results The final group consisted of 131 women. The mean age of the patients was 57 years (range 33 to 79) and parity 3.6 (range 0 to 7). The mean body mass index was 32 (range 19 to 53). Twenty-four (18.3%) women had demonstrable SUI on clinical examination at initial presentation in the clinic. At the time of urodynamic studies, forty patients (30.5%) had evidence of SUI determined by either UDS and/ or cough test in the standing position at maximum bladder capacity. Ninety-one women (69.5%) had no evidence of UI on UDS, of which 20(15.3%) demonstrated OSUI (SUI on manual reduction of prolapse at maximal bladder capacity determined by UDS). Of the 40 women with UI on UDS, 36 had 1-step surgery (combination of anti-incontinence procedure and prolapse repair) and 4 had prolapse surgery alone. Of the 20 women with OSUI on UDS, 16 had 1-step (combined) surgery and 4 prolapse surgeries only. Of the 4 who had prolapse surgery alone, 3 complained of post-operative SUI. In the group with no SUI on UDS and manual reduction of POP, 69 of the 71 women had follow-up data. Only 1 had demonstrable SUI on examination. The manual reduction test had a sensitivity of 42.9% and a specificity of 98.5% (95% CI, 92.0-99.9%). The positive predictive value was 75.0% (95% CI, 19.4-99.3%), with a high negative predictive value of 94.4% (95% CI, 86.2-98.8%). Conclusion The numbers in our study are too small to determine sensitivity and positive predictive value of UDS and manual prolapse reduction for the detection of OSUI. However, our data shows promise in identifying POP patients without OSUI, which is a complement of the hypothesis. We recommend that UDS can be performed pre-operatively in women undergoing prolapse surgery, to identify patients with urodynamic stress incontinence. Manual reduction of the prolapse at maximum bladder capacity can then be done to identify a subgroup of patients without OSUI. Future research is needed on the true predictive value of reduction stress testing with larger numbers. / AFRIKAANSE OPSOMMING: Doel van die studie Urodinamiese studies (UDS) word voorgestel as deel van die pre-operatiewe ondersoeke voor prolaps chirurgie gedoen word. Sommige vroue met genitale prolaps het verborge druklek, en selfs as hulle subjektief kontinent is, het hulle ‘n groter insidensie van de novo druklek. Die doel van die studie was om die uitkoms van ‘n groep pasiënte wat pre-operatiewe UDS en manuele prolaps reduksie gehad het, te beskryf. Metodes Die studie was ‘n retrospektiewe beskrywende studie. Al die pasiënte wat prolapse chirurgie in die tydperk Januarie 2006 tot Desember 2011 gehad het, is ingesluit. UDS en manuele prolaps reduksie tydens maksimale blaaskapasiteit, bepaal deur UDS, was deel van die roetine pre-operatiewe ondersoeke. In die gevalle waar urodinamiese druklek of verborge druklek demonstreer is, is die opsie van ‘n meegaande prosedure vir kontinensie tydens prolaps chirurgie aangebied. Post-operatiewe opvolg inligting het simptome van druklek en kliniese bewys van druklek ingesluit. Resultate Die finale groep was 131 vroue reikwydte. Die gemiddelde ouderdom van die pasiënte was 57 jaar (reikwydte 33 - 79) en pariteit 3.6 (reikwydte 0 - 7). Die gemiddelde liggaamsmassa indeks was 32 (reikwydte 19 - 53). Vier-en-twintig (18.3%) vroue het aantoonbare druklek gehad met kliniese ondersoek tydens die eerste kliniek afspraak. Tydens UDS het 40(30.5%) pasiënte druklek getoon tydens UDS en/ of hoestoets in die staande posisie teen maksimale blaaskapasiteit. Een-en-negentig (69.5%) het geen tekens van urinêre inkontinensie tydens UDS demonstreer nie, waarvan 20(15.3%) verborge druklek demonstreer het (druklek met reduksie van prolapse tydens maksimale blaaskapasiteit, bepaal deur UDS). Veertig pasiënte het urodinamiese druklek gehad, waarvan 36 een-stap chirurgie (‘n kombinasie van prolaps herstel en meegaande kontinensie prosedure) en 4 prolaps chirurgie alleenlik gehad het. Uit die 20 vroue met verborge druklek tydens UDS, het 16 een-stap (kombinasie) chirurgie en 4 prolaps chirurgie alleen gehad. Uit die 4 wat prolaps chirurgie alleen gehad het, het 3 post-operatiewe klagtes van druklek gehad. In die groep wat geen inkontinensie tydens UDS en manuele prolaps reduksie gehad het nie, het 69 van die 71 vroue opvolg data gehad. Druklek kon net by een pasiënt met ondersoek demonstreer word. Die manuele reduksie toets het ‘n sensitiwiteit van 42.9% en ‘n spesifisiteit van 98.5% (95% CI, 92.0-99.9%) gehad. Die positiewe voorspellingswaarde was 75.0% (95% CI, 19.4-99.3%), en die negatiewe voorspellingswaarde was 94.4% (95% CI, 86.2-98.8%). Gevolgtrekking Die getalle in ons studie was te min om te bepaal wat die sensitiwiteit en positiewe voorspellingswaarde van UDS and manuele prolaps reduksie is om verborge druklek te demonstreer. Die belowende data om pasiënte te identifiseer met genitale prolaps sonder verborge druklek (‘n kompliment van die hipotese). UDS kan pre-operatief gedoen word in pasiënte wat prolapse herstel chirurgie benodig, om pasiënte met urodinamiese druklek te identifiseer. Manuele reduksie van die prolaps tydens maksimum blaas kapasiteit kan dan volg, om ‘n subgroep van pasiente sonder verborge druklek, uit te ken. Verdere navorsing, met groter getalle word benodig om die werklike voorspellende waarde van die reduksie toets te ondersoek.

No description available.

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