Uterine pathologies to be considered before uterus-preserving surgery in cases of uterine prolapse

Yıl 2015, Cilt: 6 Sayı: 4, 364 - 368, 03.01.2016

Fatma Eskicioğu Beyhan Özyurt

https://doi.org/10.5799/ahinjs.01.2015.04.0550

Öz

Objective: Investigation of unpredictable risks due to abnormal uterine pathology after the choice of uterus-preserving reconstructive surgical procedure for women who have uterine prolapse and no other complaints was aimed.

Methods: The data of 121 women (105 postmenopausal and 16 premenopausal) who underwent vaginal hysterectomy due to pelvic organ prolapse was examined and the post-hysterectomy histopathology results were evaluated.

Results: Senile cystic atrophy was the most common endometrial pathology result among postmenopausal women (63.5%). However, proliferative and secretory endometrium was the most common endometrial pathology finding among premenopausal women (81.3%). There were statistically significant differences between postmenopausal and perimenopausal women in terms of these pathology results (p<0.001). While, there was no difference between groups in terms of endometrial polyps, hyperplasia and adenomyosis (p>0.05), myoma uteri was significantly more common in patients with perimenopause (p=0.01).

Conclusion: The uterus must be evaluated in terms of endometrial pathologies in asymptomatic women with pelvic organ prolapse before uterus-preserving reconstructive surgical procedure, especially in postmenopausal period. J Clin Exp Invest 2015; 6 (4): 443-446

Key words: Pelvic organ prolapse, vaginal hysterectomy, endometrium

Anahtar Kelimeler

Pelvik organ prolapsusu, vajinal histerektomi, endometrium

Kaynakça

• Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 1972;15:1048-1054.
• Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190:27-32.
• Okonkwo JE, Obiechina NJ, Obionu CN. Incidence of pelvic organ prolapse in Nigerian women. J Natl Med Assoc 2003;95:132-136.
• Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501–506.
• Woodman PJ, Swift SE, O’Boyle AL, et al. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:340-345.
• MacLennan AH, Taylor AW, DH Wilson, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery.BJOG 2000;107:1460–1470.
• Jackson SR, Avery NC, Tarlton JF, et al. Changes in metabolism of collagen in genitourinary prolapse. Lancet 1996;347:1658–1661.
• Chiaffarino F, Chatenoud L, Dindelli M, et al. Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol 1999;82:63–67.
• Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007;369:1027–1038.
• Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501–506.
• Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:437–440.
• Costantini E, Lazzeri M. What part does mesh play in urogenital prolapse management today? Curr Opin Urol 2015;25:300-304.
• Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn 2008;27:3-12.
• Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics and Gynecology 1996;175:10-17.
• Lousquy R, Costa P, Delmas V, Haab F. [Update on the epidemiology of genital prolapse]. Prog Urol 2009;19:907-915.
• Chow D, Rodríguez LV. Epidemiology and prevalence of pelvic organ prolapse. Curr Opin Urol 2013;23:293-298.
• Chung da J, Bai SW. Roles of sex steroid receptors and cell cycle regulation in pathogenesis of pelvic organ prolapse. Curr Opin Obstet Gynecol 2006;18:551-554.
• Chen HY, Wan L, Chung YW, et al. Estrogen receptor beta gene haplotype is associated with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2008;138:105-109.
• Chen HY, Chung YW, Lin WY, et al. Progesterone receptor
• polymorphism is associated with pelvic organ prolapse risk. Acta Obstet Gynecol Scand 2009;88:835-838.
• Mingels MJ, Geels YP, Pijnenborg JM, et al. Histopathologic
• assessment of the entire endometrium in asymptomatic women. Hum Pathol 2013;44:2293-2301.
• Dreisler E, Poulsen LG, Antonsen SL, et al. EMAS clinical guide: Asessment of the endometrium in peri and postmenopausal women. Maturitas 2013;75:181-190.
• Maruo T, Ohara N, Wang J, Matsuo H. Sex steroidal regulation of uterine leiomyoma growth and apoptosis. Hum Reprod 2004;10:207-220.
• Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998;4:312-322.
• Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at thetime of ysterectomy for uterovaginal prolapse. Am J Obstet Gynecol. 2010;202:507.
• Jones R NHJ, Healy JC, King LJ, et al. Pelvic connective tissue resilience decreases with vaginal delivery,menopause and uterine prolapse. Br J Surg 2003;90:466-472.
• Sivridis E, Giatromanolaki A. Proliferative activity in postmenopausal endometrium: the lurking potential for giving rise to an endometrial adenocarcinoma. J Clin Pathol 2004;57:840-844.
• Modugno F, Ness RB, Chen C, Weiss NS. Inflammation and endometrial cancer: a hypothesis. Cancer Epidemiol Biomarkers Prev 2005;14:2840-2847.
• Wallace AE, Gibson DA, Saunders PT, Jabbour HN.Inflammatory events in endometrial adenocarcinoma.J Endocrinol 2010;206:141-157.
• Bohoussou E, Adjoussou SA, Letouzey V, et al.[Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?]. J Gynecol Obstet Biol Reprod (Paris) 2014;43:40-45.
• Sherman ME. Theories of endometrial carcinogenesis:a multidisciplinary approach. Mod Pathol 2000;13:295-308.