Surgical procedure to correct genital prolapse in a patient with reduced CACNA1C gene expression in the round ligament of the uterus

Background. Genital prolapse (GP) is a disease that has a high recurrence rate after surgical correction. It is based on both the underestimation of the factors leading to GP (connective tissue incompetence, the features of microcirculation and labor course, etc.), and the stereotypes and preferences of a surgeon when choosing a method for GP surgical correction. Phenotypically, patients with GP are prominent representatives of a sarcopenia phenotype. Nevertheless, the literature lacks studies investigating the expression level of the a-1 subunit of the voltage-gated calcium channel CaV1.2 in the smooth muscle tissue of patients with GP, which may be another factor for the latter and its recurrences after surgical correction. Case report. The paper describes a 37-year-old female patient with apical GP, pelvic floor protrusion and relaxation with intact pelvic nerve conduction. The patient has connective tissue dysplasia, an Ehler-like phenotype, with the preponderance of a weak stromal and muscular component: grade 2 mitral valve prolapse, incomplete right bundle branch block, childhood myopia, joint hypermobility, arterial hypotension, minor malformations, etc. The investigators performed physical examinations, genital ultrasound evaluation, Echo-CG, special studies (defetography, pelvic nerve conduction test, sphincterometry, and anorectal manometry), and investigation of the CACNA1C gene expression in the smooth muscles of the round ligament of the uterus, by using real-time PCR. Conclusion. The authors present the combined technique for GP surgical correction, which has been developed for use in patients with hereditary multicompartmental pelvic organ prolapse.

genital prolapse, pelvic floor protrusion, defetography, pelvic nerve conduction, connective tissue dysplasia, mesh implant, hysteropexy, sarcopenia, CACNA1C gene expression, round ligament of the uterus