The pathogenetic mechanisms of the formation of pelvic organ prolapse

• Mekan R. Orazov
• Marina B. Khamoshina
• Nosenko E.N.
• Elena S. Silant’eva
• Kampos E.S.

Abstract

Objective. Pelvic organ prolapse (POP) - peripheral displacement of the uterus and/or vagina walls because of stretching of the fascial structures of the pelvis. According to the world data, from 2.9 to 53% of women note certain manifestations of genital prolapse, and up to 47%, according to different authors, these are women of working age. At the present time, the connection between the "rejuvenation" of genital prolapse. The lung forms are found with a frequency of up to 6.7% in women in the premenopausal period, and in women of reproductive age - 22.2-25%. POP has a very negative impact on the quality of life of patients and their ability to work.

Aim - to improve treatment outcomes in patients by a differentiated approach to the choice of surgical and non-surgical tactics with early stages of pelvic organ prolapse given the pathogenic mechanisms underlying it.

Material and methods. To form the review, an analysis is made of the PubMed, EMBASE, MedLine, Cochrane databases and selected international reviews of authors, with the largest randomized controlled trials in that area.

Results. A key role in the formation of POP, in addition to such recognized factors as pregnancy and childbirth, perineal trauma, increased intra-abdominal pressure and age, biochemical features of the composition of connective tissue, the amount of collagen of various types, elastin, and their ratio, as well as their effect on Its structure of various biologically active substances (MMP-2, TIMP-2 and TGF- 1), which, according to numerous researchers, is regulated genetically, as well as the ability of connective tissue cells, in particular fibroblasts, to undergo oxidative stress.

Conclusion. When comparing the data of different researchers, it becomes evident that the pathogenesis of POP requires further research. The transforming growth factor (TGF-1) stimulates the production of elastin and collagen and inhibits the degeneration of the components of the extracellular matrix, and it is naturally lowered in patients suffering from POP. According to some researchers, the amount of elastin increases in tissues in patients with POP, while others provide controversial results. The results of experimental studies have shown that apoptosis of cells is induced by mechanisms of oxidative stress, and affects the metabolism of collagen in fibroblasts. It should be emphasized that the specialist dealing with the problem of pelvic organ prolapse in women must take into account all the pathogenetic aspects of this complex disease, to navigate the anatomy and physiology, proficient in various methods of diagnosis, as well as all types of surgical interventions used in the surgical treatment.

Keywords:elastin, genital prolapse, smooth muscle actin, transforming growth factor-1, rectocele, cystocele, oxidative stress, fibroblasts

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