Genital prolapse in women of reproductive age: structural changes in the pelvic floor support system
- Autores: Remneva O.V.1, Ivanyuk I.S.1, Gal'chenko A.I.1, Semenikhina N.M.1
-
Afiliações:
- Altai State Medical University, Ministry of Health of Russia
- Edição: Nº 7 (2024)
- Páginas: 81-86
- Seção: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/635287
- DOI: https://doi.org/10.18565/aig.2024.97
- ID: 635287
Citar
Texto integral
![Acesso aberto](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_open.png)
![Acesso é fechado](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_unlock.png)
![Acesso é fechado](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
Resumo
Objective: This study aimed to examine the structural characteristics of pelvic floor muscles using ultrasound and histological examinations.
Materials and methods: In this study, 31 patients with POP-Q grade I–II genital prolapse and 30 women without pelvic organ prolapse were evaluated using pelvic floor ultrasound. The histological study involved examining muscle tissue samples from the m. levator ani obtained during the surgical correction of severe genital prolapse in 10 women.
Results: Among patients with genital prolapse, there was a significant decrease in the height of the perineal tendon center as well as the thickness of the bulbocavernosus and puborectalis muscles (p<0.05). The study group also exhibited an increase in the area of the levator fissure and levator-urethra gap. Histological examination of five m. levator ani samples revealed varying degrees of fibrosis and a decrease in the cross-sectional area of the muscle fibers.
Conclusion: Pathognomonic signs of genital prolapse include pelvic floor dysfunction and disruption of the integrity and structure of muscle fibers, characterized by the replacement of normal tissue with fibrosis and dystrophic changes.
Palavras-chave
Texto integral
![Acesso é fechado](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
Sobre autores
Ol'ga Remneva
Altai State Medical University, Ministry of Health of Russia
Autor responsável pela correspondência
Email: rolmed@yandex.ru
ORCID ID: 0000-0002-5984-1109
Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology
Rússia, BarnaulIrina Ivanyuk
Altai State Medical University, Ministry of Health of Russia
Email: Ivanukirina@yandex.ru
ORCID ID: 0000-0002-6895-7103
PhD Student at the Department of Obstetrics and Gynecology
Rússia, BarnaulAnzhelika Gal'chenko
Altai State Medical University, Ministry of Health of Russia
Email: rolmed@yandex.ru
ORCID ID: 0000-0003-3013-7764
PhD, Associate Professor at the Department of Obstetrics and Gynecology
Rússia, BarnaulNatalya Semenikhina
Altai State Medical University, Ministry of Health of Russia
Email: rolmed@yandex.ru
ORCID ID: 0000-0003-4954-1716
PhD, Associate Professor at the Department of Anatomy
Rússia, BarnaulBibliografia
- Mangir N., Roman S., Chapple C.R., MacNeil S. Complications related to use of mesh implants in surgical treatment of stress urinary incontinence and pelvic organ prolapse: infection or inflammation? World J. Urol. 2020; 38(1): 73-80. https://dx.doi.org/10.1007/s00345-019-02679-w.
- Friedman T., Eslick G.D., Dietz H.P. Risk factors for prolapse recurrence: systematic review and meta-analysis. Int. Urogynecol. J. 2018; 29(1): 13-21. https://dx.doi.org/10.1007/s00192-017-3475-4.
- Song C., Wen W., Pan L., Sun J., Bai Y., Tang J. et al. Analysis of the anatomical and biomechanical characteristics of the pelvic floor in cystocele. Acta Obstet. Gynecol. Scand. 2023; 102(12): 1661-73. https://dx.doi.org/10.1111/aogs.14657.
- Weintraub A.Y., Glinter H., Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int. Braz. J. Urol. 2020; 46(1): 5-14. https://dx.doi.org/10.1590/S1677-5538.IBJU.2018.0581.
- Чечнева М.А., Буянова С.Н., Попов А.А., Краснопольская И.В. Ультразвуковая диагностика пролапса гениталий и недержания мочи у женщин. М.: МЕДпресс-информ; 2016. 136c. [Chechneva M.A., Buyanova S.N., Popov A.A., Krasnopol'skaya I.V. Ultrasound diagnosis of genital prolapse and urinary incontinence in women. Moscow: MEDpress-inform; 2016. 136p. (in Russian)].
- Dietz H.P. Ultrasound in the assessment of pelvic organ prolapse. Best Pract. Res. Clin. Obstet. Gynaecol. 2019; 54: 12-30. https://dx.doi.org/10.1016/ j.bpobgyn.2018.06.006.
- Dietz H.P., Garnham A.P., Guzmán Rojas R. Is it necessary to diagnose levator avulsion on pelvic floor muscle contraction? Ultrasound Obstet. Gynecol. 2017; 49(2): 252-6. https://dx.doi.org/10.1002/uog.15832.
- Dietz H.P. Pelvic floor ultrasound: a review. Clin. Obstet. Gynecol. 2017; 60(1): 58-81. https://dx.doi.org/10.1097/GRF.0000000000000264.
- Liu Z., Sharen G., Wang P., Chen L., Tan L. Clinical and pelvic floor ultrasound characteristics of pelvic organ prolapse recurrence after transvaginal mesh pelvic reconstruction. BMC Womens Health. 2022; 22(1): 102. https://dx.doi.org/10.1186/s12905-022-01686-1.
- Оразов М.Р., Хамошина М.Б., Геворгян Д.А. Диагностическая эффективность трансперинеальной сонографии в верификации мышечно-фасциальных дефектов тазового дна. Клинический случай. Гинекология. 2022; 24(3): 219-22. [Orazov M.R., Khamoshina M.B., Gevorgyan D.A. Diagnostic effectiveness of transperineal sonography in the verification of musculofascial defects of the pelvic floor. A clinical case. Gynecology. 2022; 24(3): 219-22. (in Russian)]. https://dx.doi.org/10.26442/20795696.2022.3.201673.
- Токтар Л.Р., Оразов М.Р., Геворгян Д.А., Арютин Д.Г., Маркина Я.В., Достиева Ш.М., Маслюков И.А. Трансперинеальное ультразвуковое исследование в диагностике несостоятельности тазового дна. Акушерство и гинекология: новости, мнения, обучение. 2020; 8(3) Приложение: 75-9. [Toktar L.R., Orazov M.R., Gevorgyan D.A., Aryutin D.G., Markina Ya.V., Dostieva Sh.M., Maslyukov I.A. Transperineal ultrasound examination in the diagnosis of pelvic floor failure. Оbstetrics and Gynecology: News, Opinions, Training. 2020; 8(3) Supplement: 75-9. (in Russian)]. https://dx.doi.org/10.24411/2303-9698-2020-13912.
- Handa V.L., Blomquist J.L., Roem J., Muñoz A., Dietz H.P. Pelvic floor disorders after obstetric avulsion of the levator ani muscle. Female Pelvic Med. Reconstr. Surg. 2019; 25(1): 3-7. https://dx.doi.org/10.1097/SPV.0000000000000644.
- Shi W., Guo L. Risk factors for the recurrence of pelvic organ prolapse: a meta-analysis. J. Obstet. Gynaecol. 2023; 43(1): 2160929. https://dx.doi.org/10.1080/ 01443615.2022.2160929.
- Baramee P., Muro S., Suriyut J., Harada M., Akita K. Three muscle slings of the pelvic floor in women: an anatomic study. Anat. Sci. Int. 2020; 95(1): 47-53. https://dx.doi.org/10.1007/s12565-019-00492-4.
- Muro S., Akita K. Pelvic floor and perineal muscles: a dynamic coordination between skeletal and smooth muscles on pelvic floor stabilization. Anat. Sci. Int. 2023; 98(3): 407-25. https://dx.doi.org/10.1007/s12565-023-00717-7.
- Ищенко А.И., Александров Л.С., Никонов А.П., Горбенко О.Ю., Чушков Ю.В. Патоморфологические основы тазового пролапса. Медицина и экология. 2013; 4: 32-9. [Ishchenko A.I., Aleksandrov L.S., Nikonov A.P., Gorbenko O.Yu., Chushkov Yu.V. Pathomorphological bases of pelvic prolapse. Medicine and Ecology. 2013; (4): 32-9. (in Russian)].
- Лологаева М.С., Токтар Л.Р., Оразов М.Р., Арютин Д.Г., Михалёва Л.М., Мидибер К.Ю., Геворгян Д.А., Хованская Т.Н. Морфологические особенности m. levator ani при генитальном пролапсе. Доктор.Ру. 2020; 19(6): 70-8. [Lologaeva M.S., Toktar L.R., Orazov M.R., Aryutin D.G., Mikhaleva L.M., Midiber K.Yu., Gevorgyan D.A., Khovanskaya T.N. Morphology of the levator ani in patients with genital prolapse. Doctor.Ru. 2020; 19(6): 70-8. (in Russian)]. https://dx.doi.org/10.31550/1727-2378-2020-19-6-70-78.
- Kato M.K., Muro S., Kato T., Miyasaka N., Akita K. Spatial distribution of smooth muscle tissue in the female pelvic floor and surrounding the urethra and vagina. Anat. Sci. Int. 2020; 95(4): 516-22. https://dx.doi.org/10.1007/s12565-020-00549-9.
- Иванюк И.С., Ремнёва О.В., Федина И.Ю., Гальченко А.И., Мельник М.А., Трухачёва Н.В. Факторы риска дисфункции тазового дна у женщин репродуктивного возраста. Бюллетень медицинской науки. 2023; 1: 43-52. [Ivanyuk I.S., Remneva O.V., Fedina I.Yu., Gal’chenko A.I., Mel’nik M.A., Trukhacheva N.V. Risk factors for pelvic floor dysfunction in reproductive-age women. Bulletin of Medical Science. 2023; (1): 43-52. (in Russian)]. https://dx.doi.org/10.31684/25418475-2023-1-43.
- Mukund K., Subramaniam S. Skeletal muscle: a review of molecular structure and function, in health and disease. Wiley Interdiscip. Rev. Syst. Biol. Med. 2020; 12(1): e1462. https://dx.doi.org/10.1002/wsbm.1462.
Arquivos suplementares
![](/img/style/loading.gif)