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See detailChanges in elastin density in different locations of the vaginal wall in women with pelvic organ prolapse.
DE LANDSHEERE, Laurent ULg; Blacher, Silvia ULg; Munaut, Carine ULg et al

in International Urogynecology Journal & Pelvic Floor Dysfunction (2014)

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to analyze the histomorphometric properties of the vaginal wall in women with pelvic organ prolapse (POP). METHODS: In 15 women undergoing ... [more ▼]

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to analyze the histomorphometric properties of the vaginal wall in women with pelvic organ prolapse (POP). METHODS: In 15 women undergoing surgery for POP, full-thickness biopsies were collected at two different sites of location from the anterior and/or posterior vaginal wall. Properties of the precervical area (POP-Q point C/D) were compared with the most distal portion of the vaginal wall (POP-Q point Ba/Bp) using histological staining and immunohistochemistry. The densities of total collagen fibers, elastic fibers, smooth muscle cells, and blood vessels were determined by combining high-resolution virtual imaging and computer-assisted digital image analysis. RESULTS: The mean elastin density was significantly decreased in the lamina propria and muscularis layer of the vaginal wall from the most distal portion of the prolapsed vaginal wall compared with the precervical area. This difference was statistically significant in the lamina propria for both anterior (8.4 +/- 1.2 and 12.1 +/- 2.0, p = 0.048) and posterior (6.8 +/- 0.5 and 10.1 +/- 1.4, p = 0.040) locations, and in the muscularis for the anterior (5.2 +/- 0.4 and 8.4 +/- 1.2, p = 0.009) vaginal wall. There were no statistically significant differences in the mean densities of collagen fibers, smooth muscle cells or blood vessels between the two locations. CONCLUSIONS: In this study, we observed changes in elastin density in two different locations of the vaginal wall from women with POP. The histomorphometric properties of the vaginal wall can be variable from one place to another in the same patient. This result supports the existence of most vulnerable locations within the vaginal wall and the potential benefit of site-specific prolapse surgery. [less ▲]

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See detailHistology of the vaginal wall in women with pelvic organ prolapse: a literature review.
DE LANDSHEERE, Laurent ULg; Munaut, Carine ULg; Richelle, Betty ULg et al

in International Urogynecology Journal (2013), 24(12), 2011-20

INTRODUCTION AND HYPOTHESIS: The pathophysiology of pelvic organ prolapse (POP) is incompletely understood. The purpose of this study is to describe the current knowledge about histology of the vaginal ... [more ▼]

INTRODUCTION AND HYPOTHESIS: The pathophysiology of pelvic organ prolapse (POP) is incompletely understood. The purpose of this study is to describe the current knowledge about histology of the vaginal wall and its possible involvement in the pathogenesis of pelvic organ prolapse. METHODS: Eligible studies were selected through a MEDLINE search covering January 1986 to December 2012. The research was limited to English-language publications. RESULTS: Investigations of changes in the vaginal tissue that occur in women with genital prolapse are currently still limited and produced contrary results. The heterogeneity of the patients and the control groups in terms of age, parity and hormonal status, of the localization of biopsies and the histological methods as well as the lack of validation of the quantification procedures do not allow clear and definitive conclusions to be drawn. CONCLUSIONS: This review shows that current knowledge of the histological changes observed in women with POP are inconclusive and relatively limited. More studies are needed in this specific field to better understand the mechanisms that lead to POP. [less ▲]

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See detailBiomechanical Properties of Human Pelvic Organs
Rubod, Christèle; Brieu, Mathias; Cosson, Michel et al

in Urology (2012), 79(4), 96817-96822

OBJECTIVE: To comparatively define the biomechanical characteristics of the pelvic organs (the vagina, bladder, and rectum), which are crucial for the maintenance of pelvic support. Despite minimal ... [more ▼]

OBJECTIVE: To comparatively define the biomechanical characteristics of the pelvic organs (the vagina, bladder, and rectum), which are crucial for the maintenance of pelvic support. Despite minimal fundamental studies, meshes are increasingly implanted into the vesicovaginal and rectovaginal spaces to replace disrupted native tissues and to treat pelvic organ prolapse. However, the mechanical characteristics of these materials have not yet been compared with those of the “functional unit,” the vagina, bladder, and rectum. METHODS: Samples from 5 fresh female cadavers without prolapse were collected. Uniaxial tension tests under monotonic and cyclic loading were performed and the stress-strain curves obtained. RESULTS: The biomechanical properties of the vaginal, bladder, and rectal tissues differed significantly. We were able to demonstrate a nonlinear relationship between the stress and strain and a visco- hyperelastic behavior with a Mullins effect of damage of the tissues examined. Comparable rigidity was found between the investigated tissues at low strains; however, at large strain levels, marked differences could be observed. The vagina was much more rigid and less extendible than the rectal tissue, which, in turn, was more rigid than the bladder tissue. The anterior and posterior vagina revealed a different stiffness, and the bladder tissue was anisotropic at large strain levels. CONCLUSION: Our results underline the pivotal role of the vaginal tissue for the maintenance of pelvic support. The observed differences with respect to tissue rigidity should have pronounced effects on the physiologic organ function, pointing to the necessity of a differentiated view on using the same prosthetic material for different anatomic locations. [less ▲]

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See detailSurgical intervention after transvaginal Prolift mesh repair: retrospective single-center study including 524 patients with 3 years' median follow-up
DE LANDSHEERE, Laurent ULg; Ismail, Sharif; Lucot, Jean-Philippe et al

in American Journal of Obstetrics and Gynecology (2012), 206(1), 831-837

Objective The aim of this study was to explore the nature and rate of surgical intervention after transvaginal Prolift mesh repair for pelvic organ prolapse. Study Design This was a retrospective study of ... [more ▼]

Objective The aim of this study was to explore the nature and rate of surgical intervention after transvaginal Prolift mesh repair for pelvic organ prolapse. Study Design This was a retrospective study of all patients who underwent Prolift mesh repair between January 2005 and January 2009. Patient data were obtained from medical records, and patients were telephoned to check if they had surgery in other hospitals. Results A total of 600 consecutive patients were identified. Of these, 524 patients (87.3%) were included in the study, with a median follow-up duration of 38 months (range, 15–63). Global reoperation rate was 11.6%. Indications of intervention were surgery for urinary incontinence (6.9%), mesh-related complications (3.6%), or prolapse recurrence (3%). Conclusion The global reoperation rate after transvaginal Prolift mesh repair was 11.6%, with urinary incontinence surgery being the most common indication. Rates of mesh complications and prolapse recurrence are relatively low in an experienced team. [less ▲]

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See detailVagina, abdominal skin, and aponeurosis: do they have similar biomechanical properties?
Gabriel, Boris; Rubod, Chrystele; Brieu, Mathias et al

in International urogynecology journal (2011), 22(1), 23-7

INTRODUCTION AND HYPOTHESIS: despite minimal fundamental works, there is an increasing use of meshes in urogynecology. The concept is mainly based on experiences with abdominal wall surgery. We aimed to ... [more ▼]

INTRODUCTION AND HYPOTHESIS: despite minimal fundamental works, there is an increasing use of meshes in urogynecology. The concept is mainly based on experiences with abdominal wall surgery. We aimed to compare the biomechanical properties of vaginal tissue, abdominal aponeurosis, and skin. METHODS: samples from 11 fresh women cadavers without prolapse were collected. Uniaxial tension tests were performed and stress-strain curves were obtained. RESULTS: biomechanical properties of the vagina, aponeurosis, and skin differed significantly. The aponeurosis was much more rigid and less extendible than the vagina and skin. Vaginal tissue was less rigid but more extendible than skin. There was no difference between the vagina and skin at low strains (p = 0.341), but a highly significant difference at large strains (p = 0.005). CONCLUSIONS: skin and aponeurosis are not suited to predict vaginal tissue biomechanics. We should be cautious when transferring experiences from abdominal wall surgery to vaginal reconstructive surgery. [less ▲]

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See detailManagement of recurrent or persistent stress urinary incontinence after TVT-O by mesh readjustment
De Landsheere, Laurent ULg; Lucot, J. P.; Foidart, Jean-Michel ULg et al

in International Urogynecology Journal & Pelvic Floor Dysfunction (2010), 21(11), 1347-51

Introduction and hypothesis The aim of this study was to evaluate, retrospectively, the place of sub-urethral mesh readjustment when treating recurrent stress urinary incontinence (SUI) after TVT-O ... [more ▼]

Introduction and hypothesis The aim of this study was to evaluate, retrospectively, the place of sub-urethral mesh readjustment when treating recurrent stress urinary incontinence (SUI) after TVT-O. Methods Between August 2006 and August 2008, eight patients had recurrent or persistent SUI. They were treated surgically by tightening the pre-implanted sling. Results Medium delay between first surgery and mesh adjustment was 6 months. One patient needed a second TVT-O for rupture of the pre-implanted mesh during adjustment. Among the seven patients who underwent a mesh readjustment, three were cured, three improved, there was one failure. Mean follow-up was 25 months. Conclusions The sub-urethral mesh readjustment is a simple and safe procedure for patients with recurrent SIU after TVT-O procedure. Success rates are high, surgery minimally invasive but long-term follow-up is needed to evaluate efficiency. [less ▲]

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