Aging of Pelvic Floor in Animal Models: A Sistematic Review of Literature on the Role of the Extracellular Matrix in the Development of Pelvic Floor Prolapse

Association between TGF-β1 and β-catenin expression in the vaginal wall of patients with pelvic organ prolapse

The aim of this study is to investigate the mechanism of action and correlation between transforming growth factor beta 1 (TGF-β1) and β-catenin in pelvic organ prolapse (POP). The study compared vaginal wall tissues from two groups: 20 patients with POP (POP group) and 20 who had hysterectomies for benign conditions (control group). Hematoxylin and Eosin and Masson staining visualized collagen, while TUNEL staining detected apoptosis. Protein and mRNA expression levels of TGF-β1, β-catenin, matrix metallopeptidase 2 (MMP2), tissue inhibitor of metalloproteinases 2 (TIMP2), and collagen, type I, alpha 1 (COL1A1) were assessed using immunohistochemistry, quantitative real-time polymerase chain reaction, and western blot techniques. Relationships between the protein expressions of TGF-β1 and β-catenin, β-catenin and COL1A1, and TGF-β1 and COL1A1 were analyzed. In the POP group, vaginal wall collagen fibers were sparse, disorganized, and fragmented, with fewer fibers and more apoptotic cells compared to the control group. Protein and mRNA levels of TGF-β1, β-catenin, TIMP2, and COL1A1 were significantly lower, while MMP2 was higher (p < 0.05). Positive correlations were found between TGF-β1, β-catenin, and COL1A1. Reduced TGF-β1 and β-catenin levels may trigger POP by affecting pelvic floor collagen metabolism.

Urinary Incontinence (UI) in Saudi Female Population: Prevalence, Risk Factors, and Impact on Quality of Life

BACKGROUND

Urinary incontinence (UI) is a prevalent health concern among women globally. However, its prevalence, associated risk factors, and impact on quality of life among Saudi women remain underexplored.

OBJECTIVE

This study aimed to assess the prevalence of UI, identify its risk factors, and understand its impact on the quality of life among Saudi women.

METHODS

In this cross-sectional study, we surveyed Saudi women aged between 18 and 50 years. Participants were recruited from shopping malls to reflect a diverse demographic. The questionnaire included detailed questions about the participants' experiences with urinary incontinence, their lifestyle and health-related risk factors, and the impact of the condition on various aspects of their daily lives.

RESULTS

The study found a 32.4% prevalence of urinary incontinence (UI) among 516 women. Risk factors included age, marital status, BMI, childbirth, and vaginal surgery. UI prevalence increased with age and was more common in married women, women who had children, and those with vaginal surgery history. However, only 29.3% sought medical advice, and 55.2% reported no improvement after consultation. Urinary incontinence impacted respondents' lives in several ways with 38.9% reporting limitations in social activities, approximately 50% experiencing some degree of impact on household tasks, and about 19.4% facing significant or extreme impact on job or daily activities.

CONCLUSIONS

UI has a substantial prevalence among Saudi women and significantly affects their quality of life. The study underscores the need for increased awareness, routine screening, and timely medical consultation for the effective management of UI.

Morphological changes in the anterior vaginal wall caused by aging: a scanning electron microscopy study

INTRODUCTION AND HYPOTHESIS

Collagen is a protein that confers robustness and resilience to several tissues. In the female reproductive system, collagen plays a critical role in maintaining the health and function of the vaginal walls. Aging leads to collagen reduction, which may cause vaginal dryness, irritation, and prolapse. We aim to analyze the structure and profile of collagen in the anterior vaginal wall of healthy pre-menopausal (pre-M) and post-menopausal (post-M) women under a scanning electron microscope (SEM).

METHODS

Fragments of the anterior vaginal wall were collected and processed for light and scanning electron microscopy. Histological preparations were performed at first with Weigert's resorcin-fuchsin stain. Decellularized preparations were conducted, and the specimens were placed under an SEM to allow observation of the 3D organization of collagen.

RESULTS

Decellularized preparations of the pre-M specimens showed a vaginal wall with an irregular subepithelial layer, organized with ECM projections. The subepithelium evidenced the network of collagen fibrils, which seemed to support the epithelium as a basal layer. In specimens of post-M, a fusion of a network of fibrils from different direction axes was evidenced, with plate formation observed in the subepithelial plane, disfiguring the structural organization of fibrils.

CONCLUSIONS

Older specimens showed a remodeling of collagen organization in comparison with younger samples of the anterior vaginal wall.

Perinatal mesenchymal stromal cells of the human decidua restore continence in rats with stress urinary incontinence induced by simulated birth trauma and regulate senescence of fibroblasts from women with stress urinary incontinence

Stress urinary incontinence (SUI) is a condition that causes the involuntary loss of urine when making small efforts, which seriously affects daily life of people who suffer from it. Women are more affected by this form of incontinence than men, since parity is the main risk factor. Weakening of the pelvic floor tissues is the cause of SUI, although a complete understanding of the cellular and molecular mechanisms of the pathology is still lacking. Reconstructive surgery to strengthen tissue in SUI patients is often associated with complications and/or is ineffective. Mesenchymal stromal cells from the maternal side of the placenta, i.e. the decidua, are proposed here as a therapeutic alternative based on the regenerative potential of mesenchymal cells. The animal model of SUI due to vaginal distention simulating labor has been used, and decidual mesenchymal stromal cell (DMSC) transplantation was effective in preventing a drop in pressure at the leak point in treated animals. Histological analysis of the urethras from DMSC-treated animals after VD showed recovery of the muscle fiber integrity, low or no extracellular matrix (ECM) infiltration and larger elastic fibers near the external urethral sphincter, compared to control animals. Cells isolated from the suburethral connective tissue of SUI patients were characterized as myofibroblasts, based on the expression of several specific genes and proteins, and were shown to achieve premature replicative senescence. Co-culture of SUI myofibroblasts with DMSC via transwell revealed a paracrine interaction between the cells through signals that mediated DMSC migration, SUI myofibroblast proliferation, and modulation of the proinflammatory and ECM-degrading milieu that is characteristic of senescence. In conclusion, DMSC could be an alternative therapeutic option for SUI by counteracting the effects of senescence in damaged pelvic tissue.

3D Ultrasound in Pelvic Floor: Is It Useful as a Prognostic Tool in Type of Labor Development and Subsequent Pelvic Floor Diseases?

The objective of our study is to determine the thickness of the pubovisceral fasciculus of the levator ani muscle and the area of the genital hiatus by means of three-dimensional perineal ultrasound, in pregnant women in the 2nd trimester, and to analyze the related maternal, perinatal and postpartum clinical variables. Furthermore, to compare the results of our study with two similar series previously published. An observational, prospective study of pelvic floor ultrasound was carried out, performed at week 20, whose delivery was attended in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period of August from 2021 to June 2022. Maternal, ultrasound, perinatal and postpartum clinical variables were collected from each participant. During the study period, a total of 54 patients were included in it. The mean gestational age at which the ultrasound was performed was 19.81 ± 0.91 weeks. In relation to the ultrasound variables, the mean thickness of the pubovisceral muscle was 0.87 ± 0.13 cm (95% CI, 0.64-1.38 cm), while, in the plane of minimum dimension of the genital hiatus, the hiatal area at rest was 13.41 ± 3.22 (95% CI, 4.60-18.78) cm2. There is a significant correlation between the age of pregnant women (over 35 years of age) and the increase in the area of the genital hiatus (r = 0.295, p = 0.031). 3D ultrasound of the pelvic floor performed at week 20 of gestation can to be an effective, non-invasive, reproducible and cheap tool in the prognosis of the development of labor and of possible subsequent perineal dysfunctions.